TY - JOUR
T1 - Is computed tomography a necessary part of a metastatic evaluation for castration-resistant prostate cancer? Results from the Shared Equal Access Regional Cancer Hospital Database
AU - Hanyok, Brian T.
AU - Howard, Lauren E.
AU - Amling, Christopher L.
AU - Aronson, William J.
AU - Cooperberg, Matthew R.
AU - Kane, Christopher J.
AU - Terris, Martha K.
AU - Posadas, Edwin M.
AU - Freedland, Stephen J.
N1 - Publisher Copyright:
© 2015 American Cancer Society.
PY - 2016/1/15
Y1 - 2016/1/15
N2 - BACKGROUND Metastatic lesions in prostate cancer beyond the bone have prognostic importance and affect clinical therapeutic decisions. Few data exist regarding the prevalence of soft-tissue metastases at the initial diagnosis of metastatic castration-resistant prostate cancer (mCRPC). METHODS This study analyzed 232 men with nonmetastatic (M0) castration-resistant prostate cancer (CRPC) who developed metastases detected by a bone scan or computed tomography (CT). All bone scans and CT scans within the 30 days before or after the mCRPC diagnosis were reviewed. The rate of soft-tissue metastases among those undergoing CT was determined. Then, predictors of soft-tissue metastases and visceral and lymph node metastases were identified. RESULTS Compared with men undergoing CT (n = 118), men undergoing only bone scans (n = 114) were more likely to have received primary treatment (P =.048), were older (P =.013), and less recently developed metastases (P =.018). Among those undergoing CT, 52 (44%) had soft-tissue metastases, including 20 visceral metastases (17%) and 41 lymph node metastases (35%), whereas 30% had no bone involvement. In a univariable analysis, only prostate-specific antigen (PSA) predicted soft-tissue metastases (odds ratio [OR], 1.27; P =.047), and no statistically significant predictors of visceral metastases were found. A higher PSA level was associated with an increased risk of lymph node metastases (OR, 1.38; P =.014), whereas receiving primary treatment was associated with decreased risk (OR, 0.36; P =.015). CONCLUSIONS The data suggest that there is a relatively high rate of soft-tissue metastasis (44%) among CRPC patients undergoing CT at the initial diagnosis of metastases, including some men with no bone involvement. Therefore, forgoing CT during a metastatic evaluation may lead to an underdiagnosis of soft-tissue metastases and an underdiagnosis of metastases in general.
AB - BACKGROUND Metastatic lesions in prostate cancer beyond the bone have prognostic importance and affect clinical therapeutic decisions. Few data exist regarding the prevalence of soft-tissue metastases at the initial diagnosis of metastatic castration-resistant prostate cancer (mCRPC). METHODS This study analyzed 232 men with nonmetastatic (M0) castration-resistant prostate cancer (CRPC) who developed metastases detected by a bone scan or computed tomography (CT). All bone scans and CT scans within the 30 days before or after the mCRPC diagnosis were reviewed. The rate of soft-tissue metastases among those undergoing CT was determined. Then, predictors of soft-tissue metastases and visceral and lymph node metastases were identified. RESULTS Compared with men undergoing CT (n = 118), men undergoing only bone scans (n = 114) were more likely to have received primary treatment (P =.048), were older (P =.013), and less recently developed metastases (P =.018). Among those undergoing CT, 52 (44%) had soft-tissue metastases, including 20 visceral metastases (17%) and 41 lymph node metastases (35%), whereas 30% had no bone involvement. In a univariable analysis, only prostate-specific antigen (PSA) predicted soft-tissue metastases (odds ratio [OR], 1.27; P =.047), and no statistically significant predictors of visceral metastases were found. A higher PSA level was associated with an increased risk of lymph node metastases (OR, 1.38; P =.014), whereas receiving primary treatment was associated with decreased risk (OR, 0.36; P =.015). CONCLUSIONS The data suggest that there is a relatively high rate of soft-tissue metastasis (44%) among CRPC patients undergoing CT at the initial diagnosis of metastases, including some men with no bone involvement. Therefore, forgoing CT during a metastatic evaluation may lead to an underdiagnosis of soft-tissue metastases and an underdiagnosis of metastases in general.
KW - castration-resistant prostatic neoplasms
KW - computed X-ray tomography metastasis
KW - logistic models
KW - prevalence
KW - prostate-specific antigen
KW - soft-tissue neoplasms
UR - http://www.scopus.com/inward/record.url?scp=84954077392&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84954077392&partnerID=8YFLogxK
U2 - 10.1002/cncr.29748
DO - 10.1002/cncr.29748
M3 - Article
C2 - 26484853
AN - SCOPUS:84954077392
SN - 0008-543X
VL - 122
SP - 222
EP - 229
JO - Cancer
JF - Cancer
IS - 2
ER -