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Eur Urol Focus. 2017 Oct;3(4-5):480-486. doi: 10.1016/j.euf.2016.08.007. Epub 2016 Aug 29.

In Men with Castration-Resistant Prostate Cancer, Visceral Metastases Predict Shorter Overall Survival: What Predicts Visceral Metastases? Results from the SEARCH Database.

Author information

1
Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.
2
Urology Section, Veterans Affairs Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
3
Cedars-Sinai Medical Center, Division of Hematology/Oncology, Los Angeles, CA, USA.
4
Division of Urology, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
5
Urology Section, Department of Surgery, Veterans Affairs Medical Center, Greater Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA.
6
Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
7
Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA.
8
Urology Section, Division of Surgery, Veterans Affairs Medical Center and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
9
Urology Section, Veterans Affairs Medical Center, Durham, NC, USA; Department of Surgery, Division of Urology and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: stephen.freedland@cshs.org.

Abstract

BACKGROUND:

Although visceral metastases (VMs) are widely recognized to portend worse prognoses compared with bone and lymph metastases in men with metastatic castration-resistant prostate cancer (mCRPC), little is known about what predicts VMs and the extent to which men with VMs do worse.

OBJECTIVE:

To determine whether men with VMs at initial mCRPC diagnosis have worse overall survival (OS) and identify predictors of VMs.

DESIGN, SETTING, AND PARTICIPANTS:

We analyzed 494 men diagnosed with castration-resistant prostate cancer post-1999 and no known metastases from five Veterans Affairs hospitals of the Shared Equal Access Regional Cancer Hospital (SEARCH) database who later developed metastases. Radiology scans within 30 d of initial metastasis diagnosis were reviewed to collect information on bone, visceral, and lymph node metastases. We analyzed the 236 men who had a computed tomography scan performed.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Predictors of VMs and OS were evaluated using logistic regression and Cox models, respectively.

RESULTS AND LIMITATIONS:

Of the 236 mCRPC patients, 38 (16%) had VMs. Regarding VMs, 19 patients (50%), 8 patients (21%), and 16 patients (42%) had metastases in the liver, lungs, and other locations, respectively. VMs were a predictor of OS on crude analysis (hazard ratio [HR]: 1.88; 95% confidence interval [CI], 1.30-2.72; p=0.001) and after risk adjustment (HR: 1.84; 95% CI, 1.24-2.72; p=0.002). Age, year, treatment center, prostate-specific antigen (PSA), and time from CRPC to metastases were significant in predicting OS (all p<0.05). None of the variables tested were associated with having VMs (all p > 0.09). Prospective studies and larger cohorts are needed to validate our findings.

CONCLUSIONS:

Demographic, tumor, and PSA kinetic characteristics were not predictive of having VMs, but VMs predicted worse OS.

PATIENT SUMMARY:

Because patients with VMs have worse overall survival, further research is needed to develop better biomarkers and thus diagnose those with VMs at earlier stages in their disease course.

KEYWORDS:

Metastatic castration-resistant prostate cancer; Overall survival; Prostatic neoplasms; Visceral metastases

PMID:
28753787
DOI:
10.1016/j.euf.2016.08.007
[Indexed for MEDLINE]

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