Bone Metastases in Advanced Prostate Cancer

http://www.touchbriefings.com/pdf/1322/saad.pdf
a report by Fred Saad, MD, FRCSC
Director, Urologic Oncology and Professor of Surgery/Urology, University
of Montreal and
Chief of Urology, Notre-Dame Hospital, University of Montreal


<http://www.asco.org/portal/site/ASCO...tractID=33111?

Abstract No:

4555
Citation:

Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I.
Vol 24, No. 18S (June 20 Supplement), 2006: 4555
Author(s):

F. Saad, R. E. Coleman, R. Cook, M. R. Smith, J. E. Brown, J. Y. Hei, Y.
M. Chen
Abstract:


Background: Bone metastases are a significant cause of morbidity in
patients with prostate cancer (PC). To assess the predictive value of bone
markers and fractures for clinical outcome in patients with bone
metastases from PC, we conducted a retrospective analysis of patients in a
large, randomized, controlled trial of zoledronic acid.

Methods: Data were analyzed in patients treated with 4 mg zoledronic acid
or placebo who had bone marker (n = 411) or fracture (n = 640)
information. Cox regression models, adjusted for treatment group, were
used to assess the association between bone markers (urinary N-telopeptide
[NTX] and bone alkaline phosphatase [BALP]) or fractures (time-dependent
variable) and the risk of death or of experiencing a first
skeletal-related event (SRE) on study. For bone marker analyses, patients
were grouped by low (< 50 nmol/mmol creatinine), moderate (50 to 99), or
high (> 100) NTX levels and by low (< 146 U/L) or high (> 146) BALP.

Results: Patients who experienced a fracture on study (19%) had shorter
survival compared with patients who did not; the hazard ratio for death
was 1.29 (95% CI = 1.01, 1.65; P = .04), suggesting 29% increased risk of
death among these patients. When adjusted for previous SRE and baseline
ECOG performance status > 2, the risk for death associated with fractures
was increased by 23% and trended toward statistical significance (P =
..10). Patients with high NTX levels had significantly increased risk of
SREs and disease progression (P < .001) compared with patients with low
NTX. Relative to low NTX levels, high and moderate NTX levels were
associated with a 5.72-fold (95% CI = 4.04, 8.11; P < .001) and 4.10-fold
(95% CI = 2.81, 5.97; P < .001) increased risk of death, respectively.
High BALP also significantly correlated with an increased risk of a first
on-study SRE (P = .028) and bone lesion progression (P < .001).

Conclusions: These analyses suggest that pathologic fractures are
associated with increased risk if death and that high bone marker levels
are associated with increased risk of SREs, bone lesion progression, and
shorter survival in patients with PC and bone metastases. The results
support appropriate treatment for the prevention of fractures and to
decrease bone marker levels.
Other:
Abstracts by F. Saad

1.
A ligand-independent androgen receptor function protects from inositol
hexakisphosphate-induced cell death.
Meeting: 2006 ASCO Annual Meeting Abstract No: 14566 First Author: J.
Diallo
Category: Genitourinary Cancer - Prostate Cancer

2.
Effect of zoledronic acid (Z) on pain in prostate cancer patients with
bone metastases based on performance status.
Meeting: 2006 ASCO Annual Meeting Abstract No: 14544 First Author: V.
Barghout
Category: Genitourinary Cancer - Prostate Cancer

3.
Effect of zoledronic acid (Z) treatment based on serum parathyroid hormone
(PTH) levels in patients (pts) with malignant bone disease.
Meeting: 2006 ASCO Annual Meeting Abstract No: 8610 First Author: A.
Berruti
Category: Patient and Survivor Care - Supportive Care, Other

More...
Presentations by F. Saad

1.
Predictors of clinical outcome in patients with bone metastases from
prostate cancer.
Meeting: 2006 ASCO Annual Meeting
Presenter: Fred Saad
Session: Genitourinary (Prostate) Cancer (Poster Discussion)
Slides

2.
Beneficial Effects on Skeletal Complications and Bone Markers From
Zoledronic Acid Compared With Pamidronate in Prostate Cancer Patients With
Bone Metastases
No presentation available
Meeting: 2006 Prostate Cancer Symposium
Presenter: Fred Saad, MD
Session: General Poster Session C (General Poster Session)

3.
CANADIAN UROLOGIC ONCOLOGY GROUP (CUOG) PHASE II STUDY USING
DOCETAXEL/PREDNISONE IN THE SECOND LINE SETTING FOR METASTATIC ANDROGEN
INDEPENDENT PROSTATE CANCER IN PATIENTS PROGRESSING AFTER FIRST LINE
MITOXANTRONE/PREDNISONE.
No presentation available
Meeting: 2006 Prostate Cancer Symposium
Presenter: Fred Saad, MD
Session: General Poster Session E (General Poster Session)

More...
Journal of Clinical Oncology Articles by F. Saad

1.
Predictive value of bone resorption and formation markers in cancer
patients with bone metastases receiving the bisphosphonate zoledronic
Acid.
J Clin Oncol, United States
Vol 23, No 22 (6/29/2005): pp. 4925-35

2.
Natural history of rising serum prostate-specific antigen in men with
castrate nonmetastatic prostate cancer.
J Clin Oncol, United States
Vol 23, No 13 (4/30/2005): pp. 2918-25

More...
PubMed Articles by F Saad


1.
Prediction of Pathological Stage is Inaccurate in Men with PSA Values
above 20ng/mL.
Eur Urol,
Vol , No (12/19/2006): pp.
PMID: 17174466 [PubMed - in process]

2.
Presence of prostate cancer metastasis correlates with lower lymph node
reactivity.
Prostate,
Vol , No (9/7/2006): pp.
PMID: 16955408 [PubMed - in process]

3.
Treatment of sexual dysfunction of hypogonadal patients with long-acting
testosterone undecanoate (Nebido((R))).
World J Urol,
Vol , No (10/19/2006): pp.
PMID: 17048032 [PubMed - in process]