Prognostic model predicts survival in advanced prostate cancer

Researchers at the Duke Cancer Institute in Durham, NC say they have developed a tool to forecast the potential survival of individual prostate cancer patients, enabling physicians to better assess whether to try additional rounds of treatment or seek clinical trials.

Their findings are published online in the Journal of the National Cancer Institute (Oct. 17, 2013).

“Several new treatments have been developed in recent years that prolong life for men with metastatic prostate cancer,” said lead author Susan Halabi, PhD. “As a result, it’s increasingly important to provide a clear prognostic picture that can help guide both doctors and patients to the best options.”

In their study, Dr. Halabi and colleagues from several institutions developed and validated the prognostic tool using two different clinical trials of prostate cancer patients whose cancer recurred after they had undergone a regimen of docetaxel (Taxotere). By entering 17 variables-including pain intensity, measurable disease, race, age, body mass index, and others-the researchers narrowed the list to certain key factors that were relevant to overall survival.

The nine variables determined to be predictive of survival and used in the final model were Eastern Cooperative Oncology Group performance status, time since last docetaxel use, measurable disease, presence of visceral disease, pain, duration of hormonal use, hemoglobin, PSA, and alkaline phosphatase. The time-dependent area under the curves for this model were 0.73 (95% confidence interval [CI]: 0.72-0.74) and 0.70 (95% CI: 0.68-0.72) for the testing and validation sets, respectively.

Two of the factors-duration of hormone therapy and the amount of time since the first-round docetaxel treatment-had not previously been used in prognostic models.

“Our findings provide a prognostic tool that relies on information that is routinely collected in clinical practice and should be readily available,” Dr. Halabi said. “For patients with metastatic prostate cancer who are appropriate candidates for second-line chemotherapy, this model can be helpful for guiding care.”

The tool is available online at https://www.cancer.duke.edu/Nomogram/secondlinechemotheray.html.

The National Institutes of Health provided funding for the study.

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