The stable state is not an objective response in hormone-escaped carcinoma of prostate

In some clinical trials the use of criteria of stable response of hormone-escaped prostate cancer is justified on the ground that it delineates patients with markedly improved survival, similar to that of partial regression patients. Forty-three patients with hormone-escaped prostate cancer were studied in order to identify other factors which might also predict improved survival. Fifteen patients received palliative treatment only, 17 secondary hormone therapy and 11 chemotherapy. Only one objective partial regression was seen. Thirty-seven patients have died of prostatic cancer, 3 have died of other causes and 3 remain alive. The mean initial hormone response was 14.8 months, the mean time from progression to death 11.3 months, and the mean time from symptoms to death 5.9 months. There was no significant correlation between length of initial response and survival following progression (r = 0.25). Six features of progression were reviewed. Patients presenting with one feature of progression had a significantly better mean survival, 14.8 months, compared with 8.2 months when multiple features indicated progression. It is concluded that the stable state is not an objective response in hormone-escaped carcinoma of prostate but a reflection of the patient's natural disease progression and that the mode of presentation may be a significant prognostic indicator.