New Data Reveals Survival Rates for Prostate, Breast and Lung Cancer Bone Mets

“How much time do I have?” is one of the hardest questions a doctor must address when a patient is diagnosed with metastatic cancer to the bone (bone mets). It is emotionally painful for the physician to witness the fear underlying the question, and to recognize how much courage it takes for the patient to ask it. Another difficulty is the impossibility of pinning down a precise time frame. Bone mets from a primary cancer such as prostate cancer may not all behave the same, given different prostate cancer cell lines. Different primary cancers (prostate, breast, lung, etc.) may each have different survival rates. Finally, each patient has a unique set of characteristics besides the disease itself; one patient with a certain number of bones mets locations might well outlive another patient of the same age, gender, and similar bone mets profile for reasons difficult to identify. Still, the patient needs guidance in order to make realistic end of life plans, so physicians must do better than make an educated guess. This is where statistics play an important role in helping to set patient expectations.

New large-scale study

Recently, a team of Danish researchers completed a statistical analysis of bone mets survival rates based on data from over 17,000 bone mets patients from 1994-2012ⁱ. Since Denmark has tax-funded universal healthcare, its national electronic cancer registry and patient registry together offer case records for each physician or hospital visit that include such details as admission and discharge, diagnosis, procedures done, etc. For this study, the authors included adults (over age 18) with a diagnosis of bone metastasis on or after the date of primary cancer diagnosis. They placed particular focus on prostate, breast and lung cancer bone mets, the three types that account for 76% of all bone mets cases in their study (34% prostate cancer, 22% breast cancer, 20% lung cancer). There are many interesting statics in the entire article, but here is a brief table summarizing their findings on bone mets survival rates:

	Prostate Cancer	Breast Cancer	Lung Cancer
1-year survival (average)	35%	51%	10%
3-year survival (average)	12%	25%	2%
5-year survival (average)	6%	13%	1%

The authors point out that patients with metastasis only to the bone (no other organs) had longer overall survival than those with diagnosed with both bone mets and other locations at the time of diagnosis. This makes sense, because metastases in multiple locations generally indicates more advanced or aggressive disease. In addition, undetected mets in a cancer patient implies that the metastatic disease has more time to grow and progress, and by the time it is diagnosed, the patient may have a shorter life expectancy.

The authors state that their findings corroborate other research showing prostate, breast and lung cancers to be the most common source of bone mets. They note that their survival rates are lower than those reported in some other studies, most notably a U.S. study on prostate cancer bone mets to the spine that reported 73% survival at one year. However, they acknowledge that countries with high levels of PSA screening may have higher rates of earlier detection, resulting in better survival prognosis for such patients.

It’s important to keep in mind that during the 18-year time span covered by this study, many advances in detection, diagnosis and treatment have occurred. In some respects, the approach or mindset in cancer treatment has shifted from a “take no prisoners” aggressive approach that often had a negative impact on quality of life (“the cure was worse than the disease”), to a “target-treat-manage” approach that views cancer as a kind of chronic condition. In this latter view, cancers that form solid tumors, even metastatic ones, may be treated locally by minimal-to-noninvasive ablation (destruction) of each tumor, with or without accompanying systemic treatment using chemotherapy. While this method may not be curative, it “debulks” the disease without collateral damage, often significantly adding to life expectancy without demolishing quality of life.

The Sperling Medical Group offers a revolutionary treatment called MRI-guided Focused Ultrasound (MRgFUS) to manage painful bone mets. For more information, contact our trained, compassionate staff.

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ⁱSvensson E, Christiansen CF, Ulrichsen SP, Rørth MR, Sørensen HT. Survival after bone metastasis by primary cancer type: a Danish population-based cohort study. BMJ Open. 2017 Sep 11;7(9):e016022. doi: 10.1136/bmjopen-2017-016022. Full study available at http://bmjopen.bmj.com/content/7/9/e016022.long