"A Novel Prognostic Model Predicting Overall Survival in Patients With mCRPC Receiving Standard Chemotherapy"

[spouse21]

This just popped up in my morning reading: Practice Update Prostate Cancer feed. I'll leave it to the wiser HU minds to determine if the findings are based on solid research:

practiceupdate.com/content/...

TAKE-HOME MESSAGE This study aimed to develop a prognostic model to predict the overall survival (OS) of patients with metastatic castration-resistant prostate cancer (mCRPC) by using patient data from the control arms of five randomized clinical trials (ASCENT 2, VENICE, CELGENE/MAINSAIL, ENTHUSE 14, and ENTHUSE 33). The cohort was divided into two groups: a training cohort, which included 70% of the patients in the original cohort, and a validation cohort, which included the remaining 30% of the patients in the original cohort. On multivariate analysis, the following variables were noted to be predictive of OS: alkaline phosphatase levels, PSA levels, aspartate transaminase levels, BMI, hemoglobin levels, and sites of metastasis (visceral vs bone). In addition, the nomogram that was developed based on these variables showed good discrimination and calibration on external validation.This prognostic model could be used as a tool for risk stratification of patients with mCRPC in practice and clinical trials.

[LearnAll]

Good prognostic factors also include: (1) No germline mutations, (2) No family history of PCa.(3) Good performance status and ability to do physical exercise (4) Level of serum Albumin (4) Hemoglobin level (5) ALT and AST level (6) Higher normal Lymphocytes and lower normal Neutrophils. (7) Low normal Platelets (8) low normal Serum Ferritin (9) Only Bone mets. (10) Absence of abnormal Serum Calcium level.

Level of PSA at the time of diagnosis does not indicate prognosis (there are men right here who had starting PSA in thousands and are still alive after years)

How low PSA falls in first one year after starting ADT is certainly a prognostic factor.

Lower PSA falls and slower it falls in first year indicate good long term survival.

[dockam in reply to LearnAll]

Thanks for that. let me check my #s at diagnosis and see what it predicted in 2015No mutations

No family Hx

Had done 125 marathons at the Dx

Albumin 4.7

HGB - 9.9

ALT - 25

AST - 29

Lymphocytes - 1.2

Neutrophils - 29%

Platelets - 313

Ferritin - 244

No Bone mets

CA - 9.6

PSA @ Dx in 2015 at 840.2, 0.7 in 12/2015

PSA nadir at 0.1 in Summer of 2017, 18 months to get there

Obviously still here, so my one set of data points align with the above mentioned prognostic factors by LearnAll

Fight on Brothers

Randy

[dhccpa in reply to dockam]

Were you asking about readings before any treatment began?

[dockam in reply to dhccpa]

No those blood tests were done post PCa DX

[dhccpa in reply to LearnAll]

Tell me more. Low Hemo is bad?

Neutrophils/Lymphocytes ratio should be low?

Low Ferritin is bad?

Thanks

[LearnAll in reply to dhccpa]

Dockam.. most of your prognostic biomarkers are very good. That is a good news.Hemoglobin of 9.9 is not good...There is need to find out WHY? Have you ruled out Iron Deficiency Anemia? Have you checked your B12 level ? If all normal, then it might be just "Anemia of ADT."

NLR (Neutrophil to Lymphocyte Ratio) should be less than 3. Low Platelet count is good IF your bone marrow in not affected. The ratio is called PLR (platelet to lymphocyte ratio

It should be less than 100.

Need to calculate LMR too. (Lymphocyte to monocyte Ratio) should be higher than 3.

Low monocyte count indicate slow growth or stable PCa.

Also, need to check CRP (C Reactive Protein) which is an excellent marker for inflammation in the body. It is thought that those who keep CRP below 1.0 do cause slowing in growth of cancer cells.

Low Ferritin is good as it tells indirectly what is status of your PCa. Ferritin and LDH (lactate Dehydrogenase ) are also prognostic biomarkers. Low LDH is very desirable.

However, biomarkers are non specific in general...so if you have co-morbid serious medical illness ,they may not be accurate.

[dhccpa in reply to LearnAll]

You meant to reply to Dockham, but I'll assk:

Do you mean all these comments to apply upon initial diagnosis, before any PCa treatment? I ask because my red blood cell readings (RBC, Hemotocrit, and Hemoglobin, were all normal before ADT, now below normal since beginning ADT.

Thanks for your input!

[LearnAll in reply to dhccpa]

At day of diagnosis whatever biomarkers were telling is different from what biomarkers are telling today. On first day, this was how your PCa was affecting your body on that day ...and today's numbers tell how much your body has healed after Cancer has been suppressed /controlled. ADT makes hemoglobin go down ..this is known as "anemia of ADT" or "lupron induced Anemia." This happens in everyone on ADT ..less in some.. more in others.

[dockam in reply to LearnAll]

Hi, in 2015 the HGb was 9.9 (just rechecked) but now it's btwn 12.5 to 14.2 Neutrophil/Lymphocyte was 29/39Platelets at 313

Platelets/Lymphocytes 313/39

Lymphocyte/Monocyte 39/11

B12 at 1090 on 08/26/21

LDH at Dx at 169

Never had a CRP level done

Thanks for all that info

Randy

[LearnAll in reply to dockam]

Improvement in Hemoglobin level tell us that PCa has been controlled and bone marrow is functioning better now.

[dockam in reply to LearnAll]

Mahalo Brother! Great info, it's wonderful that you pass your knowledge onto us here on HU. I can't believe that I had an HGb at 9.9 in 2015 and was still able to do marathons that year😁tehachapinews.com/lifestyle...

[LearnAll in reply to dockam]

With low Hb (9.9) if you were able to do marathon....indicates that your body was still efficient and healthy enough at that time. Total health is assessed ...Not just by Hemoglobin but by a lot of other parameters taken together.One of the good prognostic feature is performance status of the man with PCa. Performance status of zero means that there is zero impairment in doing regular day to day physical activity...and it means much longer survival.

[dockam]

Oh okay, thanks for that. I'm at 4000 ft in Tehachapi and exercising up here helps my body make more RBCs as it does with Olympians who train like in Colorado, a natural Blood doping: livescience.com/32750-why-d...

[Shorehousejam]

well, PSA 942.40 at Dx July 1, 2022 PSA 0.41 September 1, 2022, not looking good for my husband with a fast falling PSA as a factor for longevity, plus he germline brca found blm, bloom,

reading these boards tonight has destroyed my faith…