Colette A Whitney1, Lauren E Howard2, Edwin M Posadas3, Christopher L Amling4, William J Aronson5, Matthew R Cooperberg6, Christopher J Kane7, Martha K Terris8, Stephen J Freedland9. 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.
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.
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