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Cancer. 2016 Jan 15;122(2):222-9. doi: 10.1002/cncr.29748. Epub 2015 Oct 20.

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.

Author information

1
Urology Section, Veterans Affairs Medical Center, Durham, North Carolina.
2
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
3
Division of Urology, Department of Surgery, Oregon Health and Science University, Portland, Oregon.
4
Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, California.
5
Department of Urology, University of California Los Angeles Medical Center, Los Angeles, California.
6
Division of Urology, Department of Surgery, University of California San Francisco Medical Center, San Francisco, California.
7
Division of Urology, Department of Surgery, University of California San Diego Medical Center, San Diego, California.
8
Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, Georgia.
9
Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia.
10
Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
11
Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
12
Center for Integrated Research in Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.

Abstract

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. Cancer 2015. © 2015 American Cancer Society. Cancer 2016;122:222-229. © 2015 American Cancer Society.

KEYWORDS:

castration-resistant prostatic neoplasms; computed X-ray tomography metastasis; logistic models; prevalence; prostate-specific antigen; soft-tissue neoplasms

PMID:
26484853
DOI:
10.1002/cncr.29748
[Indexed for MEDLINE]
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