Prognostic grouping of metastatic prostate cancer using conventional pretreatment prognostic factors

Objective. To develop three prognostic groups for disease specific mortality based on the binary classified pretreatment variables age, haemoglobin concentration (Hb), erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP), prostate-specific antigen (PSA), plasma testosterone and estradiol level in hormonally treated patients with metastatic prostate cancer (PCa). Material and methods. The present study comprised 200 Finnprostate 6 study patients, but data on all variables were not known for every patient. The patients were divided into three prognostic risk groups (Rgs) using the prognostically best set of pretreatment variables. The best set was found by backward stepwise selection and the effect of every excluded variable on the binary classification cut-off points of the remaining variables was checked and corrected when needed. Results. The best group of variables was ALP, PSA, ESR and age. All data were known in 142 patients. Patients were given one risk point each for ALP > 180 U/l (normal value 60–275 U/l), PSA > 35 µg/l, ESR > 80 mm/h and age < 60 years. Three risk groups were formed: Rg-a (0–1 risk points), Rg-b (2 risk points) and Rg-c (3–4 risk points). The risk of death from PCa increased statistically significantly with advancing prognostic group. Conclusion. Patients with metastatic PCa can be divided into three statistically significantly different prognostic risk groups for PCa-specific mortality by using the binary classified pretreatment variables ALP, PSA, ESR and age.