prostate cancer prognosis | Prognostic factors for prostate CANCER treated with first-line hormone therapy

Prognostic factors for prostate CANCER treated with first-line hormone therapy



Objective: The hormonal treatment of prostate cancer is intended to suppress the action of androgens in order to counteract the growth of hormone-sensitive neoplastic cells. The duration and quality of the response to this treatment are variable from one patient to the next. The purpose of our study was to evaluate the prognostic factors of patients treated with first-line hormone therapy for prostate cancer. Material and methods: from September 1988 to September 1999, 170 patients with prostate cancer treated with first-line hormone therapy were included. Hormonal treatment was LH-RH analogues alone in 59.4% of cases, a complete androgènique blockade in 21.2% of cases, anti-androgens alone in 17.6% of cases and estrogens in 1.8% of cases. Clinical, biological, scans and anatomo-pathological data have been collected. Overall survival was studied in uni-variate analysis based on pretherapeutic criteria using Kaplan-Meier survival curves.
Results: The average survival of the population was 33 ± 26 months (2-126 months). The following parameters were associated with a significant decrease in overall survival: Patients over 70 years of age, high ECOG score, mode of revelation of cancer by alteration of the general condition, presence of bone pain, presence of bone metastases Especially at the level of the appendicular skeleton, dilation of renal cavities, Gleason score > 5, PSA rate > 100 ng/ml, hemoglobin rate < 13.5 g/dl, creatinine > 105 µmol/L, low testostéronémie, high alkaline phosphatase rate, Poor response to treatment enjoyed by PSA levels greater than 4 ng/ml at 3, 6, and 12 months.
Conclusion: Knowledge of these prognostic factors predicts the response to hormonal treatment and patient survival. These factors also allow for the grouping of comparable patients for clinical trials.

Prostate cancer is the second cause of cancer mortality in humans after bronchial cancer, responsible in 1977 in France for 11% of human cancer deaths, or 9100 deaths [15].

HUGGINS [11] had shown in 1941 the neuro-endocrine regulation of the gonadal function and the androgèno-dependence of malignant prostatic cells. Since then, hormonal treatment to suppress the action of androgens is offered to patients with metastasized or locally advanced cancer in order to improve their survival and quality of life. This treatment of prostate cancer has no curative effect. About 70 to 80% of patients have a clinical response to hormonal treatment but with a therapeutic exhaust occurring on average between 18 and 36 months.

The prognosis of hormone-resistant prostate cancer is bad, with 50% death at 1 year. The efficacy of second-line treatment is low, and chemotherapy can be offered in clinical trials.

The duration of the response to hormonal treatment remains unpredictable in answering patients: 10% live less than 6 months, 50% live under 3 years and 10% live more than 10 years [15]. Interest has been focused on the prognostic factors of patients treated with hormone therapy since the introduction of clinical trials. Many work has focused on the search for a severity index of prostate tumors or on the contrary of factors showing favorable prognosis. However, it is always difficult to accurately evaluate the aggressiveness and extension of the tumor as well as the predictable response to hormonal treatment.

There are several reasons for determining these prognostic factors: knowing the history of the disease and the factors influencing it, defining the different effects of the treatment, optimizing the intensity of the treatment according to the prognosis and Stratify patients and therapeutic modalities in different clinical trials.

The objective of this study was to identify prognostic factors for survival in a population with locally advanced or metastatic prostate cancer treated first-line by hormonal treatment.

Materials and methods
This retrospective study was conducted from 170 records of patients with prostate cancer, histologically proven, locally advanced or metastatic, treated first-line by a chemical suppression androgenic of September 1988