Pretreatment visceral metastases in castration resistant metastatic prostate cancer: role in prediction versus actual site of disease progression.

To evaluate the anatomic site(s) of initial disease progression in patients with castration resistant metastatic prostate cancer (mCRPC) in the presence or absence of pre-treatment visceral metastases while on systemic therapy.

This is a retrospective cohort study of mCRPC patients who have baseline and at least one follow up bone scan and CT chest, abdomen and pelvis (CAP). Disease progression was determined by RECIST and/or ≥ 30% increase in automated bone scan lesion area score. Kaplan-Meier plot was used to estimate the median progression free survival and log-rank tests were used to compare anatomic sites.

Of 203 patients, 61 (30%) had pre-treatment visceral metastases. Patients with baseline visceral disease were 1.5 times more likely to develop disease progression (HR = 1.53; 95% CI, 1.03-2.26). Disease progression was a result of worsening bone scan disease (42% (16/38)) versus visceral (32% (12/38)) or lymph node disease (3% (1/38)) by CT or a combination thereof (23% (9/38)). Median time to progression (TTP) did not differ by anatomic location of initial progression (p = 0.86). Development of new lesions occurred in 50% of those visceral patients with soft tissue only progression and was associated with a significantly longer TTP (3.1 months (2.8-4.3 months) than those with worsening of pre-existing lesions (1.8 months (1.6-2.7 months); p = 0.04.

Patients with pre-treatment visceral metastases in mCRPC are more likely to experience disease progression of bone disease with the initial anatomic site of progression similar to those without baseline visceral involvement.

Cancer imaging : the official publication of the International Cancer Imaging Society. 2022 Jul 14*** epublish ***

Kathleen Ruchalski, Hyun J Kim, Michael Douek, Steven Raman, Maitraya Patel, Victor Sai, Antonio Gutierrez, Benjamin Levine, Cheryce Fischer, Martin Allen-Auerbach, Pawan Gupta, Heidi Coy, Bianca Villegas, Matthew Brown, Jonathan Goldin

Department of Radiological Sciences, UCLA, Los Angeles, CA, USA. ., Department of Radiological Sciences, UCLA, Los Angeles, CA, USA., Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA., UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA, USA.

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