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

Incidence and survival of castration-resistant prostate cancer patients with visceral metastases: results from the Dutch CAPRI-registry

BACKGROUND

The objective of this real-world population study is to investigate incidence and treatment of visceral metastases (VMs) in castration resistant prostate cancer (CRPC) patients and their survival.

METHODS

CRPC-patients in the CAPRI-registry between 2010 and 2016 were included in the analyses and followed till 2017. Outcomes were proportion of patients radiologically screened for VMs and proportion of patients with VMs at CRPC-diagnosis and at the start of every treatment line. Groups have been created based on location of VMs (lung, liver, or both) at date of first VM diagnosis. The outcome for these groups was overall survival (OS). Statistics included descriptive analyses, Kaplan-Meier method, and Cox proportional hazard regression analysis for survival analyses.

RESULTS

Of 3602 patients from the CAPRI registry, 457 patients (12.7%) were diagnosed with VMs during follow-up: 230 patients with liver, 161 with lung, and 66 with both liver and lung metastases. The proportion of patients radiologically screened for VMs increased per treatment line as did the occurrence rate of VMs. However, 80% of patients at CRPC diagnosis to 40% in the 6th line were not screened for VMs at the start of a systemic treatment. Median OS was 8.6 months for patients with liver, 18.3 with lung and 10.9 with both liver and lung metastases (p < 0.001) from date of first VM diagnosis. After correction for prognostic factors patients with lung metastases had significantly better OS than patients with liver metastases (HR 0.650, p = 0.001).

CONCLUSION

This real-world analysis showed that despite the increased rate of radiological staging during follow-up, still 80% to 40% of the patients (CRPC diagnosis to 6th treatment line respectively) were not screened for VMs at the start of a systemic treatment. VMs and location of VMs are key prognostic patient characteristics, impacts survival and have implications for treatment decisions, so routine staging of CRPC-patients is warranted.

CLINICAL TRIAL IDENTIFICATION

The CAPRI study is registered in the Dutch Trial Registry as NL3440 (NTR3591).

Impact of age, comorbidity, and PSA doubling time on long-term competing risks for mortality among men with non-metastatic castration-resistant prostate cancer

BACKGROUND

Understanding competing risks for mortality is critical in determining prognosis among men with non-metastatic castration-resistant prostate cancer (nmCRPC), a disease state that often affects older men and has substantial heterogeneity in risk of cancer mortality. We sought to determine the impact of age, comorbidity, and PSA doubling time (PSADT) on competing risks for mortality in men with nmCRPC.

METHODS

We conducted a retrospective analysis of 1238 patients diagnosed with nmCRPC in 2000-2015 in the SEARCH database. Multivariable Cox proportional hazards and competing risks regression were used to determine the hazards of overall, prostate cancer-specific (PCSM), and other-cause mortality (OCM) across age, Charlson comorbidity index (CCI), and PSADT subgroups.

RESULTS

Men with nmCRPC were elderly (median age 77) and had substantial comorbidity burdens (CCI > 1 n = 701, 57%). Multivariable Cox analysis showed higher CCI was associated with higher hazard of OCM, while slower PSADT was associated with lower hazard of PCSM across all age subgroups. Among those with CCI ≥ 3 (vs. CCI0), the hazard ratio of OCM was 2.7 (95% CI 1.1-6.3), 2.0 (95% CI 1.1-3.6), and 2.5 (95% CI 1.5-4.0) for those aged <70, 70-79, and ≥80, respectively. Among those with PSADT ≥ 9 months (vs. < 9 months), the hazard ratios for PCSM were 0.5 (95% CI 0.3-0.9), 0.6 (95% CI 0.4-0.9), and 0.6 (95% CI 0.4-0.9) for those aged <70, 70-79, and ≥80. Competing risks curves revealed PCSM was the predominant cause of death for those with PSADT < 9 months across all age and comorbidity groups. PCSM and OCM were relatively equal competitors for mortality among those with PSADT≥9 months except those aged > 80 with CCI ≥ 3, in whom OCM was the predominant cause of death.

CONCLUSIONS

Among men with nmCRPC, age, comorbidity, and PSADT are associated with risk and cause of death and may assist clinicians in counseling patients regarding cancer prognosis.

Pattern and Distribution of Distant Metastases in Anaplastic Prostate Carcinoma: A Single-Institute Experience With 101 Patients

OBJECTIVE

The aim of this study was to evaluate the sites and frequencies of distant metastases in patients with anaplastic prostate carcinoma and to correlate those findings with prostate-specific antigen (PSA) levels.

MATERIALS AND METHODS

Patients with anaplastic prostate carcinoma (n = 101) underwent CT and bone scans before platinum-based chemotherapy. CT findings were retrospectively reviewed to identify the sites of metastases. CT findings were correlated with baseline PSA levels. The Wilcoxon rank sum test was used to correlate PSA levels between patients with metastases at osseous and nonosseous sites. The Wilcoxon rank sum test was also used to correlate the type of bone metastases (blastic vs lytic) and the PSA levels.

RESULTS

Eighty-three of 101 patients (82%) had osseous metastases. PSA levels were significantly higher in patients with bone metastases than in patients without osseous metastases. However, 23 of the 83 patients (28%) with bone metastases had PSA levels in the normal range (i.e., < 4 ng/mL). The type of bone metastases (blastic vs lytic) did not show any statistically significant correlation to the PSA levels. Overall, 63 of 101 patients (62%) had nonosseous distant metastases at one or more sites, including the liver (n = 34), lung (n = 24), mediastinum (n = 31), pleura (n = 7), brain (n = 9), adrenal glands (n = 6), peritoneum (n = 4), and spleen (n = 1). PSA levels were not significantly elevated in patients with nonosseous distant metastases. Twenty-six of the 63 patients (41%) with nonosseous metastases had PSA levels in the normal range (< 4 ng/mL).

CONCLUSION

Patients with the anaplastic clinical variant of prostate cancer have a high frequency of typical and atypical sites of metastases. Common sites of nonosseous distant metastases include the liver, lung, mediastinum, pleura, brain, and adrenal glands. PSA levels are unreliable and may be disproportionately low, despite the presence of multifocal large-volume metastases. CT of the chest, abdomen, and pelvis should be considered in routine staging and follow-up of patients with anaplastic prostate carcinoma regardless of their PSA levels.

Use of dual-phase contrast computed tomography for evaluation of the normal canine male genital tract

OBJECTIVES

To evaluate the use of dual-phase contrast-enhanced computed tomography for the depiction of the features of the male genital tract, highlighting differences between entire and neutered dogs.

METHODS

Computed tomography exams of 23 entire and 23 neutered male dogs with no history of urogenital disease were included in this retrospective study, with exams acquired pre-, 30 and 98·9 ±27·4 seconds after intravenous contrast administration. The genital structures were subjectively evaluated for visibility, contrast enhancement and enhancement pattern and differences between entire and neutered dogs were described. Objective measurements of attenuation and size of the prostatic tissue were acquired.

RESULTS

The root, body and glans of the penis could be evaluated in all dogs and appeared larger in entire dogs, though objective measurements could not be reliably made because these structures are small and curved. There was contrast enhancement of the cavernous structures, most reliably in the bulb and corpus spongiosum and most frequently in entire dogs in the delayed post-contrast phase. In entire dogs, the small testicular vessels most commonly had a vermiform shape in the early post-contrast phase, and a homogeneous appearance in the delayed phase. Sternal recumbency with the coxofemoral joints extended improved visibility of the genital structures.

CLINICAL SIGNIFICANCE

Dual-phase contrast-enhanced computed tomography is useful for depiction of the structures of the male genital tract, with the early phase especially highlighting the vascular and the delayed phase the cavernous structures.