The commonly used serum (blood) marker for inflammation is C-reactive protein (CRP). It is believed that CRP has a prognostic impact for men with metastatic prostate cancer (MPC) (advanced prostate cancer). The researchers conducted a meta-analysis to quantitate its prognostic impact.
They conducted asystematic review to identify publications and presentations exploring the association of baseline serum CRP and overall survival (OS) in MPC, both castration-sensitive and castration-resistant.
After performing some statistical manipulations of the data they determined that six studies comprising 659 evaluable patients were eligible. The first authors of the six studies were: Prins (N=119), Pond (N=112), Ito (N=80), Nakashima (N=126), Beer (N=160), and McArdle (N=62). The Nakashima and McArdle studies evaluated castration-sensitive men, while the remaining four studies evaluated castration-resistant men receiving docetaxel-based chemotherapy.
The primary endpoint was overall survival (OS) except the McArdle study, which used cancer specific survival.
Men with higher CRP (more inflammation) had significantly worse OS than those with lower CRP (HR = 1.42, P<0.001, 95% CI: 1.17 to 1.73; I2 = 72.6%, p = 0.003). In trials of castration-sensitive men receiving hormonal therapy, high CRP yielded a HR = 1.92 (P=0.005, 95% CI: 1.22 to 3.03; I2 = 0). In castration-resistant men receiving chemotherapy, high CRP yielded HR=1.35 (p=0.003, 95% CI: 1.11 to 1.65; I2 = 79%), P for subgroup difference=0.20.
The meta-analysis suggests a strong prognostic impact for CRP on OS in men with both castration-sensitive and castration-resistant prostate cancer. Prospective validation is justified, given the affordability, ready availability and large dynamic range of CRP.
What might we do with this information? This study concludes that men with higher levels of inflammation have a worse prognostic outlook. Can lowering a man’s CRP improve their OS? Until this type of study is conducted we cannot answer this question, but given our ability to control inflammation it is an issue that should be discussed with your doctor.
Inflammation can be controlled by drugs and by diet and exercise. Clearly diet and exercise is a thing any of us should be able to control. What is a healthy, anti-inflammatory diet? There are many different takes on this, but The anti-inflammatory diet is “probably very close to the Mediterranean diet ” says Christopher Cannon, MD, associate professor of medicine at Harvard Medical School and a cardiologist at Brigham and Women’s Hospital, Boston.
J Clin Oncol 32, 2014 (suppl 4; abstr 43); Gurudatta Naik, Charity Morgan, Pedro Filipe Simoes da Rocha, Arnoud J. Templeton, Gregory Russell Pond, Guru Sonpavde; University of Alabama at Birmingham, Birmingham, AL; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Alabama, Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL
Joel T. Nowak, M.A., M.S.W.