Factors predictive of skeletal-related events (SREs) in bone metastatic
prostate cancer patients with
hormone-refractory disease were investigated. We evaluated the frequency of SREs in 200
hormone-refractory patients consecutively observed at our Institution and followed until death or the last follow-up. Baseline parameters were evaluated in univariate and multivariate analysis as potential predictive factors of SREs. Skeletal-related events were observed in 86 patients (43.0%), 10 of which (5.0%) occurred before the onset of
hormone-refractory disease. In univariate analysis, patient performance status (P=0.002), disease extent (DE) in bone (P=0.0001), bone
pain (P=0.0001), serum
alkaline phosphatase (P=0.0001) and urinary
N-telopeptide of type one
collagen (P=0.0001) directly correlated with a greater risk to develop SREs, whereas Gleason score at diagnosis, serum PSA, Hb,
serum albumin, serum
calcium, types of bone lesions and duration of
androgen deprivation
therapy did not. Both DE in bone (hazard ratio (HR): 1.16, 95% confidence interval (CI): 1.07-1.25, P=0.000) and
pain score (HR: 1.13, 95% CI: 1.06-1.20, P=0.000) were independent variables predicting for the onset of SREs in multivariate analysis. In patients with heavy tumour load in bone and great bone
pain, the percentage of SREs was almost twice as high as (26 vs 52%, P<0.02) and occurred significantly earlier (P=0.000) than SREs in patients with limited DE in bone and low
pain. Bone
pain and DE in bone independently predict the occurrence of SREs in bone metastatic
prostate cancer patients with
hormone-refractory disease. These findings could help physicians in tailoring the skeletal follow-up most appropriate to individual patients and may prove useful for stratifying patients enrolled in
bisphosphonate clinical trials.