What is the life expectancy with prostate cancer that has metastasized to the pelvic bones?

Life Expectancy in Prostate Cancer with Pelvic Bone Metastases

Patients with metastatic castration-resistant prostate cancer (CRPC) with bone metastases have a median survival of less than 2 years. 1

Prognostic Factors Affecting Survival

Survival in patients with metastatic prostate cancer to the bones depends on several key factors:

1. Disease Status:

   • Castration-resistant status significantly worsens prognosis
   • More than 90% of patients with CRPC have bone metastases 1

2. Disease Burden:

   • Minimal disease burden is associated with longer survival 2
   • Extent of bone involvement correlates with prognosis

3. Performance Status:

   • Better performance status correlates with improved survival 2
   • Functional decline often precedes mortality

4. Symptom Burden:

   • Absence of bone pain is a positive prognostic indicator 2
   • Symptomatic disease generally indicates more advanced progression

5. Tumor Characteristics:

   • Lower Gleason score is associated with better outcomes 2
   • Lower PSA levels at diagnosis correlate with improved survival

Survival Statistics

The survival statistics for patients with metastatic prostate cancer to bone are sobering:

• Median survival for metastatic CRPC: Less than 2 years 1
• Median survival from time of recurrence (all sites): 27 months 3
• 5-year survival rates from recurrence:
  • All recurrences: 24%
  • Pelvic recurrence only: 50%
  • Distant metastases (with or without pelvic recurrence): Significantly worse 3

Treatment Considerations

Treatment can significantly impact survival in patients with bone metastases:

1. Palliative Radiation:

   • Effective for managing bone pain
   • Single fraction of 800 cGy is as effective as multiple fractions for non-vertebral metastases 1

2. Hormonal Therapy:

   • Salvage therapy with hormones improves 5-year survival rates (70% vs 21% without hormonal therapy) 3
   • Median time to androgen independence: 14-30 months 1

3. Radiopharmaceuticals:

   • Appropriate for patients with widespread metastatic disease
   • Options include strontium-89 and samarium-153 1

4. Monitoring Response:

   • Bone scans and CT are complementary modalities for monitoring
   • PSA may not always be reliable in patients on androgen deprivation therapy 1

Prognostic Limitations

Despite identifying statistically significant baseline characteristics, accurately predicting long-term survival remains challenging:

• In one study, only 13% of patients who lived ≥10 years were correctly predicted based on prognostic models 2
• However, 98% of patients who died within 5 years were correctly identified 2

Conclusion

For patients with prostate cancer metastatic to pelvic bones, the prognosis is generally poor, with median survival typically less than 2 years once the disease becomes castration-resistant. However, individual outcomes can vary significantly based on disease burden, performance status, symptoms, and response to treatment.

Early palliative interventions, including radiation therapy and appropriate systemic treatments, can help manage symptoms and potentially extend survival in selected patients.