Hormone-resistant prostate cancer with symptomatic pelvic tumours: patientsurvival and prognostic factors

Objectives To determine the survival and investigate the prognostic signifi cance of immunohistochemical variables and clinical factors in patients wit h hormone-resistant prostate cancer (HRPC) and symptomatic pelvic tumours, in whom preliminary observations indicated that survival exceeded the media n 8-10 months of patients with HRPC and painful bone metastases. Patients and methods Seventy-five patients with HRPC referred for palliativ e pelvic radiotherapy between 1980 and 1996 were identified. For all patien ts at least two prostate biopsies had been obtained, one before primary hor mone treatment and at least one after clinical progression despite androgen deprivation (HRPC biopsy). Bone scans at the time of referral were assesse d. The medical records were reviewed for clinical variables of possible pro gnostic significance. Histological grade was recorded, and prostate-specifi c antigen (PSA), androgen receptors (ARs), Ki-67 and p53 determined immunoh istochemically, In 18 HRPC specimens the degree of AR amplification was ana lysed. Results Positive staining for ARs was high in the HRPC biopsies, although t here was no association with AR amplification. Ki-67 positivity increased a fter the development of HRPC. The median (range) survival was 14(1-141) mon ths; age<65 years was associated with increased survival, In a multivariate analysis the following variables remained independent prognostic factors f or survival from the time of the HRPC biopsy: bone metastases (0-10 vs >10 lesions, P <0.001), low Ki-67 score (0 vs 1-3, P = 0.006) and Low p53 posit ivity score (0 vs 1-3, P=0.014) in the HRPC biopsy. Conclusions The median survival of patients with HRPC and pelvic tumours re quiring palliation seems to exceed that of patients with HRPC and dominatin g painful bone metastases by at least 4-6 months. Simple clinical (bone met astases) and immunohistochemical variables (Ki-67, p53) enable patients wit h particularly long survival times to be identified, and in whom palliative treatment needs to be improved.