Abstract
Information on the impact of bone metastasis and skeletal-related events (SREs) on mortality among prostate cancer patients is limited. Using the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified men aged 65 years or older diagnosed with prostate cancer between July 1 1999 and December 31 2005 and followed to determine deaths through December 31 2006. We classified subjects as having bone metastasis and SREs as indicated by Medicare claims. Using Cox regression, we estimated mortality hazards ratios (HR) among men with bone metastasis with or without SRE, compared with men without bone metastasis. Among 126 978 men with prostate cancer (median follow-up, 3.3 years), 9746 (7.7%) had bone metastasis at prostate cancer diagnosis (1.7%) or during follow-up (5.9%). SREs occurred in 4296 (44%) men with bone metastasis. HRs for risk of death were 6.6 (95% CI=6.4–6.9) and 10.2 (95% CI=9.8–10.7), respectively, for men with bone metastasis but no SRE and for men with bone metastasis plus SRE, compared with men without bone metastasis. Bone metastasis was associated with mortality among prostate cancer patients. This association appeared to be stronger for bone metastasis plus SRE than for bone metastasis without SRE.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Validation of Algorithms to Identify Bone Metastases Using Administrative Claims Data in a Japanese Hospital
Drugs - Real World Outcomes Open Access 18 January 2023
-
Radiomics for detecting prostate cancer bone metastases invisible in CT: a proof-of-concept study
European Radiology Open Access 24 September 2021
-
Real-world safety and effectiveness of radium-223 in Japanese patients with castration-resistant prostate cancer (CRPC) and bone metastasis: exploratory analysis, based on the results of post-marketing surveillance, according to prior chemotherapy status and in patients without concomitant use of second-generation androgen-receptor axis-targeted agents
International Journal of Clinical Oncology Open Access 11 February 2021
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Rent or buy this article
Get just this article for as long as you need it
$39.95
Prices may be subject to local taxes which are calculated during checkout

References
Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W et al. (eds) SEER Cancer Statistics Review, 1975–2007 http://seer.cancer.gov/csr/1975_2007/. based on November 2009 SEER data submission, posted to the SEER web site, 2010.
Carlin BI, Andriole GL . The natural history, skeletal complications, and management of bone metastases in patients with prostate carcinoma. Cancer 2000; 88: 2989–2994.
Bridwell KH . Treatment of metastatic prostate cancer of the spine. Urol Clin North Am 1991; 18: 153–159.
Keller ET, Zhang J, Cooper CR, Smith PC, McCauley LK, Pienta KJ et al. Prostate carcinoma skeletal metastases: cross-talk between tumor and bone. Cancer Metastasis Rev 2001; 20: 333–349.
Weinfurt KP, Li Y, Castel LD, Saad F, Timbie JW, Glendenning GA et al. The significance of skeletal-related events for the health-related quality of life of patients with metastatic prostate cancer. Ann Oncol 2005; 16: 579–584.
Ryan CJ, Elkin EP, Cowan J, Carroll PR . Initial treatment patterns and outcome of contemporary prostate cancer patients with bone metastases at initial presentation: data from CaPSURE. Cancer 2007; 110: 81–86.
Cooperberg MR, Broering JM, Carroll PR . Risk assessment for prostate cancer metastasis and mortality at the time of diagnosis. J Natl Cancer Inst 2009; 101: 878–887.
Conti G, La Torre G, Cicalese V, Micheletti G, Ludovico MG, Vestita GD et al. Prostate cancer metastases to bone: observational study for the evaluation of clinical presentation, course and treatment patterns. Presentation of the METAURO protocol and of patient baseline features. Arch Ital Urol Androl 2008; 80: 59–64.
Norgaard M, Jensen AO, Jacobsen JB, Cetin K, Fryzek J, Sorensen HT . Skeletal related events, bone metastasis and survival of prostate cancer: A population based cohort study in Denmark (1999–2007). J Urol 2010; 184: 162–167.
Potosky AL, Riley GF, Lubitz JD, Mentnech RM, Kessler LG . Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care 1993; 31: 732–748.
Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF . Overview of the SEER-medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 2002; 40: IV–3-18.
Gornick ME, Warren JL, Eggers PW, Lubitz JD, De Lew N, Davis MH et al. Thirty years of medicare: impact on the covered population. Health Care Financ Rev 1996; 18: 179–237.
Merrill RM . Partitioned prostate cancer prevalence estimates: an informative measure of the disease burden. J Epidemiol Community Health 2001; 55: 191–197.
Romano PS, Roos LL, Jollis JG . Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993; 46: 1075–1079 discussion 81–90.
Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43: 1130–1139.
Gooley TA, Leisenring W, Crowley J, Storer BE . Estimation of failure probabilities in the presence of competing risks: new representation of old estimators. Stat Med 1999; 18: 695–706.
Kalbfleish JD, Prentice RL . The Statistical Analysis of Failure Time Data. Wiley: New York, 1980.
Cox DR . Regression models and life-tables (with discussion). J R Stat Soc Ser B 1972; 34: 187–220.
Salonia A, Gallina A, Camerota TC, Picchio M, Freschi M, DaPozzo LF et al. Bone metastases are infrequent in patients with newly diagnosed prostate cancer: analysis of their clinical and pathologic features. Urology 2006; 68: 362–366.
Goodin S, Rao KV, DiPaola RS . State-of-the-art treatment of metastatic hormone-refractory prostate cancer. Oncologist 2002; 7: 360–370.
Clarke NW, Hart CA, Brown MD . Molecular mechanisms of metastasis in prostate cancer. Asian J Androl 2009; 11: 57–67.
Saad F . Bone metastases in advanced prostate cancer. A report. Business briefing. Eur Pharmacother 2005, 2–6. Available from http://www.touchbriefings.com/cdps/cditem.cfm?NID-1134
Rigaud J, Tiguert R, Le Normand L, Karam G, Glemain P, Buzelin JM et al. Prognostic value of bone scan in patients with metastatic prostate cancer treated initially with androgen deprivation therapy. J Urol 2002; 168: 1423–1426.
Bubendorf L, Schopfer A, Wagner U, Sauter G, Moch H, Willi N et al. Metastatic patterns of prostate cancer: an autopsy study of 1589 patients. Hum Pathol 2000; 31: 578–583.
Inoue T, Segawa T, Kamba T, Yoshimura K, Nakamura E, Nishiyama H et al. Prevalence of skeletal complications and their impact on survival of hormone refractory prostate cancer patients in Japan. Urology 2009; 73: 1104–1109.
Dodwell DJ . Malignant bone resorption: cellular and biochemical mechanisms. Ann Oncol 1992; 3: 257–267.
Guise TA, Mundy GR . Cancer and bone. Endocr Rev 1998; 19: 18–54.
Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Leach GE et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 1995; 273: 129–135.
Villavicencio H . Quality of life of patients with advanced and metastatic prostatic carcinoma. Eur Urol 1993; 24 (Suppl 2): 118–121.
Saad F, Gleason DM, Murray R, Venner P, Tchekmedyian NS, Lacombe L et al. Zoledronic acid is well tolerated for up to 24 months and significantly reduces skeletal complications in patients with advanced prostate cancer metastatic to bone (abstr 1472). Presented at American Urological Association Annual Meeting; 26 April—1 May, 2003; Chicago, Illinois.
Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L et al. Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. J Natl Cancer Inst 2004; 96: 879–882.
Cereceda LE, Flechon A, Droz JP . Management of vertebral metastases in prostate cancer: a retrospective analysis in 119 patients. Clin Prostate Cancer 2003; 2: 34–40.
Yokomizo A, Koga H, Shinohara N, Miyahara T, Machida N, Tsukino H et al. Skeletal-related events in urological cancer patients with bone metastasis: a multicenter study in Japan. Int J Urol 2010; 17: 332–336.
Oefelein MG, Ricchiuti V, Conrad W, Resnick MI . Skeletal fractures negatively correlate with overall survival in men with prostate cancer. J Urol 2002; 168: 1005–1007.
Coleman RE . Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001; 27: 165–176.
Kuban DA, el-Mahdi AM, Sigfred SV, Schellhammer PF, Babb TJ . Characteristics of spinal cord compression in adenocarcinoma of prostate. Urology 1986; 28: 364–369.
Rubin H, Lome LG, Presman D . Neurological manifestation of metastatic prostatic carcinoma. J Urol 1974; 111: 799–802.
Osborn JL, Getzenberg RH, Trump DL . Spinal cord compression in prostate cancer. J Neurooncol 1995; 23: 135–147.
Shoskes DA, Perrin RG . The role of surgical management for symptomatic spinal cord compression in patients with metastatic prostate cancer. J Urol 1989; 142: 337–339.
Smith EM, Hampel N, Ruff RL, Bodner DR, Resnick MI . Spinal cord compression secondary to prostate carcinoma: treatment and prognosis. J Urol 1993; 149: 330–333.
Zelefsky MJ, Scher HI, Krol G, Portenoy RK, Leibel SA, Fuks ZY . Spinal epidural tumor in patients with prostate cancer. Clinical and radiographic predictors of response to radiation therapy. Cancer 1992; 70: 2319–2325.
Schisterman EF, Cole SR, Platt RW . Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology 2009; 20: 488–495.
Acknowledgements
This work was supported by a research contract from Amgen. This research is supported by a contract between UAB and Amgen. Only the authors from UAB have access to the Medicare data used. The analysis, presentation and interpretation of the results are solely the responsibility of the authors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Sathiakumar, N., Delzell, E., Morrisey, M. et al. Mortality following bone metastasis and skeletal-related events among men with prostate cancer: a population-based analysis of US Medicare beneficiaries, 1999–2006. Prostate Cancer Prostatic Dis 14, 177–183 (2011). https://doi.org/10.1038/pcan.2011.7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/pcan.2011.7
Keywords
- bone metastasis
- skeletal-related events
- prostate cancer bone involvement
- mortality
This article is cited by
-
Validation of Algorithms to Identify Bone Metastases Using Administrative Claims Data in a Japanese Hospital
Drugs - Real World Outcomes (2023)
-
The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 3: prostate cancer
British Dental Journal (2022)
-
Castration-resistant prostate cancer with bone metastases: toward the best therapeutic choice
Medical Oncology (2022)
-
Evaluation of prostate health index in predicting bone metastasis of prostate cancer before bone scanning
International Urology and Nephrology (2022)
-
Radiomics for detecting prostate cancer bone metastases invisible in CT: a proof-of-concept study
European Radiology (2022)