Prognostic factors of survival rate in patients with prostate cancer

Introduction. Despite the disappointing statistics of morbidity and mortality rates, prostate cancer is a slow growing tumor and does not always lead to death. Thus, it is of paramount importance for oncologists to decide who should receive aggressive treatment of rapidly progressing prostate cancer and who should undergo gentle treatment or just monitoring due to the slow growing form of tumor, which is less dangerous for ones life. This problem stems from the lack of or from the incomplete understanding of prognostic information about the course of the disease from the moment of its diagnosis. Materials and methods. A retrospective analysis of treating 1127 patients with prostate cancer was conducted. 495 patients received radical prostatectomy (surgical treatment group); 256 patients received combined X-ray and hormone therapy; 305 patients underwent androgen deprivation, and 71 patients were included into a delayed treatment group with active surveillance and wait-and-see policy. The study included 447 (39.7%) patients with localized prostate cancer, 399 (35.4%) patients with locally advanced prostate cancer and 281 (24.9%) patients with metastatic prostate cancer. Results. Multi-factor analysis revealed independent prognostic factors for every group, which allows to predict the further course of the disease. In the group of patients with surgical treatment, oncospecific survival (OS) was mostly affected by metastases to lymph nodes: 5-year and 10-year OS rates dropped to 86.9% and 65.9%, respectively, with 99.4% and 97.5% survival rates at the N0 stage (p = 0.012). Good somatic status (Charlson index 1). In the group of distant X-ray therapy, the longevity of androgen deprivation (36 months) mostly affected the OS (RR = 0.79, CI = 0.61-0.97, p = 0.027); GS was mostly depended on the age of men, under 70 (RR = 0.85, CI = 0.72-0.96, p=0.018). In the group of androgen deprivation, the most crucial factor affecting the OS was the PSA nadir level > 4 ng/ml: 5-year and 10-year OS rates dropped from 56.2% and 5.9% to 28.7% and 0%, respectively (p = 0.004); GS was also affected by the PSA nadir level