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

Brian T. Hanyok, Lauren E. Howard, Christopher L. Amling, William J. Aronson, Matthew R. Cooperberg, Christopher J. Kane, Martha K. Terris, Edwin M. Posadas, Stephen J. Freedland

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)222-229
Number of pages8
JournalCancer
Volume122
Issue number2
DOIs
StatePublished - Jan 15 2016

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Cancer Care Facilities
Castration
Prostatic Neoplasms
Tomography
Databases
Neoplasm Metastasis
Bone and Bones
Odds Ratio
Lymph Nodes
Prostate-Specific Antigen
Bone Neoplasms

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

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. / Hanyok, Brian T.; Howard, Lauren E.; Amling, Christopher L.; Aronson, William J.; Cooperberg, Matthew R.; Kane, Christopher J.; Terris, Martha K.; Posadas, Edwin M.; Freedland, Stephen J.

In: Cancer, Vol. 122, No. 2, 15.01.2016, p. 222-229.

Research output: Contribution to journalArticle

Hanyok, Brian T. ; Howard, Lauren E. ; Amling, Christopher L. ; Aronson, William J. ; Cooperberg, Matthew R. ; Kane, Christopher J. ; Terris, Martha K. ; Posadas, Edwin M. ; Freedland, Stephen J. / 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. In: Cancer. 2016 ; Vol. 122, No. 2. pp. 222-229.
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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.",
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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.

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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.

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