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Clinical Research

Who dies from prostate cancer?



During the last 30 years, there has been a major shift in initial staging in prostate cancer (CaP) in Western countries, with the incidence of metastases at diagnosis decreasing from over 50% in the 1970s to currently less than 10%. Yet, CaP is still the second cause of cancer death in men. We used two monthly curated databases of patients with castration-resistant prostate cancer (CRPC) to describe the natural history of patients dying of CaP in the modern era.


The outcome of 190 men with metastatic CRPC treated from 2008 to 2011 was studied. The characteristics of the patients who died from CaP (n=113 patients, 61%) were analyzed.


All 113 patients who died of CaP were assessable for the presence of metastases at diagnosis. Sixty-three patients (56%) had detectable metastases at diagnosis: 67%, 11% and 43% had bone, visceral and lymph node metastases, respectively. The median time to CRPC was 16 months and median overall survival (OS) was 5.2 years.

Among the patients with localized CaP at diagnosis (n=50, 44%), 46% had T stage3 and 38% had a Gleason score8. Overall, 64% of patients were classified as having a high-risk CaP. Only 26% who died from CaP had a Gleason score6. Median OS was 8.8 years.


In the modern era, approximately half of the patients who die from CaP have metastases at diagnosis. The paradigm of progression from localized disease to metastasis and eventually death is only represented in the other half, although possible initial screening and staging errors ought to be taken into consideration. More efforts are needed to conduct trials in patients with newly diagnosed metastatic CaP.

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  1. Siegel R, Naishadham N, Jemal A . Cancer Statistics, 2012. CA Cancer J Clin 2012; 62: 10–29.

    Article  Google Scholar 

  2. Postma R, van Leenders A, Roobol MJ, Schröder FH, van der Kwast TH . Tumor features in the control and screening arm of a randomized trial of prostate cancer. Eur Urol 2006; 50: 70–75.

    Article  PubMed  Google Scholar 

  3. Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012; 366: 981–990.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chowdhury S, Robinson D, Cahill DD, Rodriguez-Vida A, Holmberg L, Møller H . Causes of death in men with prostate cancer: an analysis of 50 000 men from the Thames Cancer Registry. BJU Int 2013; 112: 182–189.

    Article  PubMed  Google Scholar 

  5. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 2013; 49: 1374–1403.

    CAS  Article  PubMed  Google Scholar 

  6. Riihimaki M, Thomsen H, Brandt A, Sundquist J, Hemminki K . What do prostate cancer patients die of? Oncologist 2011; 16: 175–181.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Epstein M, Edgren G, Rider JR, Mucci LA, Adami HO . Temporal trends in cause of death among Swedish and US men with prostate cancer. J Natl Cancer Inst 2012; 104: 1335–1342.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Scher HI, Halabi S, Tannock I, Morris M, Sternberg CN, Carducci MA et al. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 2008; 26: 1148–1159.

    Article  PubMed  PubMed Central  Google Scholar 

  9. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280: 969–974.

    Article  PubMed  Google Scholar 

  10. Johansson JE, Andrén O, Andersson SO, Dickman PW, Holmberg L, Magnuson A et al. Natural history of early, localized prostate cancer. JAMA 2004; 291: 2713–2719.

    CAS  Article  PubMed  Google Scholar 

  11. Millikan RE, Wen S, Pagliaro LC, Brown MA, Moomey B, Do KA et al. Phase 3 trial of androgen ablation with or without three cycles of systemic chemotherapy for advanced prostate cancer. J Clin Oncol 2008; 26: 5936–5942.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wang J, Halford S, Rigg A, Roylance R, Lynch M, Waxman J . Adjuvant mitoxantrone chemotherapy in advanced prostate cancer. BJU Int 2000; 86: 675–680.

    CAS  Article  PubMed  Google Scholar 

  13. Gravis G, Fizazi K, Joly F, Oudard S, Priou F, Estemi B et al. Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomized, open-label, phase 3 trial. Lancet Oncol 2013; 14: 149–158.

    CAS  Article  PubMed  Google Scholar 

  14. NLM Identifier NCT00268476. STAMPEDE: Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy: A Multi-Stage Multi-Arm Randomized Controlled Trial.

  15. Sweeney C, Chen YH, Carducci MA, Jarrrad DF, Eisenberg MA, Wong YN et al. Impact on overall survival (OS) with chemohormonal therapy versus hormonal therapy for hormone-sensitive newly metastatic prostate cancer (mPrCa): An ECOG-led phase III randomized trial. J Clin Oncol 2014; 32: 5 s (suppl; abstr LBA2).

    Article  Google Scholar 

  16. NLM Identifier NCT01957436. A prospective randomized phase III study of androgen deprivation therapy with or without local radiotherapy with or without abiraterone acetate and prednisone in patients with metastatic hormone-naïve prostate cancer.

  17. NLM Identifier NCT01715285. A study of abiraterone plus low-dose prednisone plus androgen-deprivation therapy (ADT) versus ADT alone in newly-diagnosed patients with high-risk, metastatic hormone-naïve prostate cancer (mHNPC).

  18. Montgomery RB, Joshua A, Hannah AL, Peterson AC, Lopez C, Gleave ME et al. A randomized, open-label, phase II study of MDV3100 alone or in combination with leuprolide and dutasteride as neoadjuvant therapy to prostatectomy in intermediate and high-risk prostate cancer. J Clin Oncol 2012; 30 (suppl; abstr TPS4695).

  19. Haffner MC, Mosbruger T, Esopi DM, Fedor H, Heaphy CM, Walker DA et al. Tracking the clonal origin of lethal prostate cancer. J Clin Invest 2013; 123: 4918–4922.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. Kruck S, Gakis G, Stenzl A . Circulating and disseminated tumor cells in the management of advanced prostate cancer. Adv Urol 2012; 2012: 135281.

    Article  PubMed  Google Scholar 

  21. Weckermann D, Polzer B, Ragg T, Blana A, Schlimok G, Arnholdt H et al. Perioperative activation of disseminated tumor cell in bone marrow of patients with prostate cancer. J Clin Oncol 2009; 27: 1549–1556.

    Article  PubMed  Google Scholar 

  22. Osisami M, Keller ET . Mechanisms of metastatic tumor dormancy. J Clin Med 2013; 2: 136–150.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 2006; 7: 472–479.

    CAS  Article  PubMed  Google Scholar 

  24. Grimm MO, Kamphausen S, Hugenschmidt H, Stephan-Odenthal M, Ackermann R, Vögeli TA . Clinical outcome of patients with lymph node-postive cancer after radical prostatectomy versus androgen deprivation. Eur Urol 2002; 41: 628–634.

    Article  PubMed  Google Scholar 

  25. Gjertson CK, Asher KP, Sclar JD, Goluboff ET, Olsson CA, Benson MC et al. Local control and long-term disease-free survival for stage D1 (T2-T4N1-N2M0) prostate cancer after radical prostatectomy in the PSA Era. Urology 2007; 70: 723–727.

    Article  PubMed  Google Scholar 

  26. Fizazi K, Lesaunier F, Delva R, Gravis G, Rolland F, Priou F et al. A phase III trial of docetaxel-estramustine in high-risk localized prostate cancer: a planned analysis of response, toxicity and quality of life in the GETUG 12 trial. Eur J Cancer 2012; 18: 209–217.

    Article  Google Scholar 

  27. NLM Identifier NCT01952223. A Phase III of Cabazitaxel and Pelvic Radiotherapy in Localized Prostate Cancer and High-risk Features of Relapse (PEACE2).

  28. Taplin M, Montgomery RB, Logothetis C, Bubley GJ, Richie JP, Dalkin BL et al. Effect of neoadjuvant abiraterone acetate (AA) plus leuprolide acetate (LHRHa) on PSA, pathological complete response (pCR), and near pCR in localized high-risk prostate cancer (LHRPC): Results of a randomized phase II study. J Clin Oncol 2012; 30 (suppl; abstr 4521).

  29. Efstathiou E, Davis JW, Troncoso P, Titus MA, Hoang A, Wen S et al. Cytoreduction and androgen signaling modulation by abiraterone acetate (AA) plus leuprolide acetate (LHRHa) versus LHRHa in localized high-risk prostate cancer (PCa): preliminary results of a randomized preoperative study. J Clin Oncol 2012; 30 (suppl; abstr 4556).

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Correspondence to K Fizazi.

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Patrikidou, A., Loriot, Y., Eymard, JC. et al. Who dies from prostate cancer?. Prostate Cancer Prostatic Dis 17, 348–352 (2014).

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