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Hirano H, Nagata M, Nagaya N, Nakamura S, Ashizawa T, Lu Y, Kawano H, Kitamura K, Sakamoto Y, Fujita K, Isobe H, Tsujimura A, Muto S, Horie S. Bone scan index (BSI) scoring by using bone scintigraphy and circulating tumor cells (CTCs): predictive factors for enzalutamide effectiveness in patients with castration-resistant prostate cancer and bone metastases. Sci Rep 2023; 13:8704. [PMID: 37248346 DOI: 10.1038/s41598-023-35790-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/24/2023] [Indexed: 05/31/2023] Open
Abstract
Reports of Bone Scan Index (BSI) calculations as imaging biomarkers to predict survival in patients with metastatic castration-resistant prostate cancer (mCRPC) have been mainly from retrospective studies. To evaluate the effectiveness of enzalutamide (ENZ) in Japanese patients with mCRPC and bone metastases using BSI (bone scintigraphy) and circulating tumor cell (CTC) analysis. Prospective, single-arm study at Juntendo University affiliated hospitals, Japan. Patients were administered 160 mg ENZ daily, with 3 monthly assessments: BSI, prostate specific antigen (PSA), CTC and androgen receptor splicing variant-7 (AR-V7) status. Primary endpoint: BSI-decreasing rate after ENZ treatment. Secondary endpoints: PSA-decreasing rate and progression free survival (PFS). Statistical analyses included the Wilcoxon t-test, Cox proportional hazard regression analysis, and log-rank test. Median observation period: 17.9 months, and median PFS: 13.8 (2.0-43.9) months (n = 90 patients). A decrease in BSI compared to baseline as best BSI change on ENZ treatment was evident in 69% patients at the end of the observation period (29% patients showed a complete response, BSI 0.00). At 3 months 67% patients showed a ≥ 50% PSA reduction, and 70% after ENZ treatment. PSA decline (3 months) significantly associated with a prolonged median PFS: 18.0 (estimated) versus 6.4 months (HR 2.977 [95% CI 1.53-5.78], p = 0.001). Best BSI decline response significantly associated with a prolonged PFS: 18.1(estimated) versus 7.8 months (HR 2.045 [95% CI: 1.07-3.90], p = 0.029). CTC negative status (n = 20) significantly associated with a prolonged PFS: 13.4 [estimated] vs 8.6 months (HR 2.366, 95% CI 0.97-5.71, p = 0.041). CTC positive/AR-V7 positive status significantly associated with a shorter PFS: 5.9 months (HR 8.56, 95% CI 2.40-30.43, p = 0.0087). -reduction (3 months) and BSI-reduction (on ENZ treatment) were significant response biomarkers, and a negative CTC status was a predictive factor for ENZ efficacy in patients with mCRPC.
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Affiliation(s)
- Hisashi Hirano
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
| | - Masayoshi Nagata
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
| | - Naoya Nagaya
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
| | - So Nakamura
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
| | - Takeshi Ashizawa
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
| | - Yan Lu
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
| | - Kosuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan
- Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yoshiro Sakamoto
- Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kazuhiko Fujita
- Department of Urology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hideyuki Isobe
- Department of Urology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 1138431, Japan.
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Thellenberg-Karlsson C, Vjaters E, Kase M, Tammela T, Ojamaa K, Norming U, Nyman C, Andersson SO, Hublarovs O, Marquez-Holmberg M, Castellanos E, Ullen A, Holmberg A, Nilsson S. A randomised, double-blind, dose-finding, phase II multicentre study of ODX in the treatment of patients with castration-resistant prostate cancer and skeletal metastases. Eur J Cancer 2023; 181:198-207. [PMID: 36682096 DOI: 10.1016/j.ejca.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
AIMS This study aimed to assess the efficacy and safety of ODX, a novel, cytotoxic, bone-targeting drug candidate, in castration-resistant prostate cancer bone metastatic disease. METHODS Patients with progressive disease were randomised to ten cycles of ODX, intravenous infusion Q2W (3, 6, and 9 mg/kg, respectively). The primary objective was to assess the relative change from baseline in bone alkaline phosphatase (B-ALP) and serum-aminoterminal-propeptide of Type I procollagen (S-P1NP) at 12 weeks. The inclusion criteria selected were broad, and a double-blind design was used to ensure objective recruitment of patients for the assessment of efficacy. None of the patients received bone-protecting agents during the ODX treatment period. RESULTS Fifty-five 21,20 and 14) patients were randomised to ODX (3, 6 and 9 mg/kg), respectively. The lower number of patients in arm 3 was due to too low a recruitment rate towards the end of the study. The median treatment time were 14, 13 and 14 weeks, respectively. The decrease in B-ALP at 12 weeks in study arms 3, 6 and 9 mg/kg was seen in 6/15 (40%), 8/12 (67%) and 5/12 (42%) patients, respectively, whereas the corresponding numbers for P1NP were 8/15 (53%), 8/12 (67%), and 4/12 (33%), respectively. The median decrease in B-ALP and P1NP at 12 weeks for study arms 3, 6 and 9 mg/kg were 37%, 14% and 43%, respectively, and 51%, 40% and 64%, respectively. The decrease in serum C-terminal telopeptide at 12 weeks was seen in the vast majority of patients and in about one-third of patients in bone scan index. ODX was well tolerated, and no drug-related serious adverse events occurred. There were no significant differences between study arms regarding efficacy and safety. CONCLUSIONS ODX was well tolerated and demonstrated inhibitory effects on markers related to the vicious cycle in bone at all three doses. The reduction in metastatic burden, assessed with bone scan index, supports this finding. Studies with continued ODX treatment until disease progression are being planned (ClinicalTrials.gov Identifier: NCT02825628).
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Affiliation(s)
| | - Egils Vjaters
- Pauls Strandis Clinical University Hospital, Pilsonu Iela 13, Riga, Latvia.
| | - Marju Kase
- Tartu University Hospital, L.Puusepa 8, Tartu, Estonia.
| | - Teuvo Tammela
- Tampere University Hospital, Urology Clinic, Teiskontie 35, Tampere, Finland.
| | | | - Ulf Norming
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden.
| | - Claes Nyman
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden.
| | | | | | | | | | - Anders Ullen
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna.
| | - Anders Holmberg
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna; Dextech Medical, Box 389, 751 06 Uppsala.
| | - Sten Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna.
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Nakai Y, Iemura Y, Miyasaka T, Hori S, Miyake M, Marugami N, Fujimoto K, Tanaka N. Clinical Significance of the Highest Regional Bone Scan Index in Patients with Metastatic Castration-Resistant Prostate Cancer. Nucl Med Mol Imaging 2022; 56:221-227. [PMID: 36310836 PMCID: PMC9508292 DOI: 10.1007/s13139-022-00759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 10/16/2022] Open
Abstract
Purpose This study evaluated the clinical utility of the highest bone scan index (BSI), among other BSIs, for each bone metastatic site in patients with bone metastatic castration-resistant prostate cancer (bmCRPC). Methods Thirty patients, diagnosed with bmCRPC by bone scintigraphy, were included. Total BSI, the number of hot spots, and regional BSI on each hot spot from bone scintigraphy at diagnosis with bmCRPC were evaluated by VSBONE BSI®. Highest regional BSI was defined as the highest value among regional BSIs on each hot spot in each patient. Related factors to overall survival and skeletal-related events (SREs) were evaluated using the Cox proportional-hazards model. Results The median follow-up time from diagnosis with bmCRPC was 29.0 months. During this time, 24 patients died, of which 22 patients died from prostate cancer. On univariate analysis, alkaline phosphatase (ALP) [Hazard ratio (HR): 5.96, 95% confidence interval (CI): 2.05-17.3] and highest regional BSI (HR: 2.01, 95% CI: 1.17-7.05) had significant correlation with overall survival. On multivariate analysis, ALP (HR: 4.79, 95% CI: 1.61-14.2) had significant correlation with overall survival. SREs were found in eight patients. Only the highest regional BSI (HR: 9.99, 95% CI: 2.46-40.6) significantly correlated with SREs on univariate analysis. Conclusion Highest regional BSI may provide important information regarding prognosis and SREs in patients with bmCRPC.
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Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Yusuke Iemura
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Toshiteru Miyasaka
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Nagaaki Marugami
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Nobumichi Tanaka
- Department of Brachytherapy for Prostate, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
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Marchioni M, Marandino L, Amparore D, Berardinelli F, Matteo F, Campi R, Schips L, Mascitti M. Factors influencing survival in metastatic castration resistant prostate cancer therapy. Expert Rev Anticancer Ther 2022; 22:1061-1079. [PMID: 35982645 DOI: 10.1080/14737140.2022.2114458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The number of patients with metastatic castration resistant prostate cancer (mCRPC) is expecting to increase due to the long-life expectancy of those with advanced disease who are also more commonly diagnosed today because of stage migration. Several compounds are available for treating these patients. AREAS COVERED We reviewed currently available treatments for mCRPC, their mechanism of action and resistance and we explored possible predictors of treatment success useful to predict survival in mCRPC patients. EXPERT OPINION A combination of molecular, clinical, pathological, and imaging features is necessary to correctly estimate patients' risk of death. The combination of these biomarkers may allow clinicians to tailor treatments based on cancer history and patients' features. The search of predictive biomarkers remains an unmet medical need for most patients with mCRPC.
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Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Laura Marandino
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Berardinelli
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Ferro Matteo
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Marco Mascitti
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
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Regula N, Kostaras V, Johansson S, Trampal C, Lindström E, Lubberink M, Iyer V, Velikyan I, Sörensen J. Comparison of 68Ga-PSMA PET/CT with fluoride PET/CT for detection of bone metastatic disease in prostate cancer. Eur J Hybrid Imaging 2022; 6:5. [PMID: 35229224 PMCID: PMC8885936 DOI: 10.1186/s41824-022-00127-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background 18F-NaF positron emission tomography/computed tomography (fluoride PET/CT) is considered the most sensitive technique to detect bone metastasis in prostate cancer (PCa). 68Ga-PSMA-11 (PSMA) PET/CT is increasingly used for staging of PCa. This study primarily aimed to compare the diagnostic performance of fluoride PET/CT and gallium-based PSMA PET/CT in identifying bone metastasis followed by a comparison of PSMA PET/CT with contrast-enhanced CT (CE-CT) in identifying soft tissue lesions as a secondary objective. Methods Twenty-eight PCa patients with high suspicion of disseminated disease following curative treatment were prospectively evaluated. PET/CT examinations using fluoride and PSMA were performed. All suspicious bone lesions were counted, and the tracer uptake was measured as standardized uptake values (SUV) for both tracers. In patients with multiple findings, ten bone lesions with highest SUVmax were selected from which identical lesions from both scans were considered for direct comparison of SUVmax. Soft tissue findings of local and lymph node lesions from CE-CT were compared with PSMA PET/CT. Results Both scans were negative for bone lesions in 7 patients (25%). Of 699 lesions consistent with skeletal metastasis in 21 patients on fluoride PET/CT, PSMA PET/CT identified 579 lesions (83%). In 69 identical bone lesions fluoride PET/CT showed significantly higher uptake (mean SUVmax: 73.1 ± 36.8) compared to PSMA PET/CT (34.5 ± 31.4; p < 0.001). Compared to CE-CT, PSMA PET/CT showed better diagnostic performance in locating local (96% vs 61%, p = 0.004) and lymph node (94% vs 46%, p < 0.001) metastasis. Conclusion In this prospective comparative study, PSMA PET/CT detected the majority of bone lesions that were positive on fluoride PET/CT. Further, this study indicates better diagnostic performance of PSMA PET/CT to locate soft tissue lesions compared to CE-CT. Supplementary Information The online version contains supplementary material available at 10.1186/s41824-022-00127-4.
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Miyoshi Y, Tsutsumi S, Kawahara T, Yasui M, Uemura K, Yoneyama S, Yokomizo Y, Hayashi N, Yao M, Uemura H. Prognostic value of automated bone scan index for predicting overall survival among bone metastatic castration resistant prostate cancer patients treated with radium‐223. BJUI COMPASS 2020; 2:24-30. [PMID: 35474664 PMCID: PMC8988825 DOI: 10.1002/bco2.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yasuhide Miyoshi
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Sohgo Tsutsumi
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Masato Yasui
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Koichi Uemura
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Shuko Yoneyama
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Yumiko Yokomizo
- Department of Urology Yokohama City University School of Medicine Yokohama Japan
| | - Narihiko Hayashi
- Department of Urology Yokohama City University School of Medicine Yokohama Japan
| | - Masahiro Yao
- Department of Urology Yokohama City University School of Medicine Yokohama Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
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Song H, Jin S, Xiang P, Hu S, Jin J. Prognostic value of the bone scan index in patients with metastatic castration-resistant prostate cancer: a systematic review and meta-analysis. BMC Cancer 2020; 20:238. [PMID: 32197590 PMCID: PMC7085171 DOI: 10.1186/s12885-020-06739-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 01/02/2023] Open
Abstract
Background Many studies have reported the prognostic significance of the bone scan index (BSI) for metastatic castration-resistant prostate cancer (mCRPC); however, these reports are controversial. This study investigated the BSI in mCRPC and its relationship with prognosis. Methods The PubMed, Cochrane, and Embase databases were searched systematically for relevant articles published before September 1, 2019. Hazard ratios (HRs) were used to investigate the prognostic value. Results This study finally identified 9 eligible studies. The results suggested that high baseline BSI predicted poor OS (HR = 1.331, 95% CI: 1.081–1.640) and that elevated ΔBSI also predicted poor OS (HR = 1.220, 95% CI: 1.015–1.467). The subgroup analysis stratified by ethnicity showed that the baseline BSI and ΔBSI predicted poor OS in the Asian population but not in the Caucasian population. We also performed a subgroup analysis based on the different cut-off values of baseline BSI. The subgroup of ≤1 showed a significant association with OS in mCRPC patients. Conclusion Our study demonstrated that high baseline BSI and elevated ΔBSI predicted poor OS in patients with mCRPC. Hence, the BSI can serve as a prognostic indicator for mCRPC patients and may therefore guide clinical treatment in the future.
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Affiliation(s)
- Hualin Song
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China.,National Research Center for Genitourinary Oncology, Beijing, China.,Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, China
| | - Song Jin
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Peng Xiang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuai Hu
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China. .,National Research Center for Genitourinary Oncology, Beijing, China. .,Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, China.
| | - Jie Jin
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China. .,National Research Center for Genitourinary Oncology, Beijing, China. .,Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, China.
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Armstrong AJ, Anand A, Edenbrandt L, Bondesson E, Bjartell A, Widmark A, Sternberg CN, Pili R, Tuvesson H, Nordle Ö, Carducci MA, Morris MJ. Phase 3 Assessment of the Automated Bone Scan Index as a Prognostic Imaging Biomarker of Overall Survival in Men With Metastatic Castration-Resistant Prostate Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2019; 4:944-951. [PMID: 29799999 DOI: 10.1001/jamaoncol.2018.1093] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Prostate cancer commonly metastasizes to bone, and bone metastases are associated with pathologic fractures, pain, and reduced survival. Bone disease is routinely visualized using the technetium Tc 99m (99mTc) bone scan; however, the standard interpretation of bone scan data relies on subjective manual assessment of counting metastatic lesion numbers. There is an unmet need for an objective and fully quantitative assessment of bone scan data. Objective To clinically assess in a prospectively defined analysis plan of a clinical trial the automated Bone Scan Index (aBSI) as an independent prognostic determinant of overall survival (OS) in men with metastatic castration-resistant prostate cancer (mCRPC). Design, Setting, and Participants This investigation was a prospectively planned analysis of the aBSI in a phase 3 multicenter randomized, double-blind, placebo-controlled clinical trial of tasquinimod (10TASQ10). Men with bone metastatic chemotherapy-naïve CRPC were recruited at 241 sites in 37 countries between March 2011 and August 2015. The statistical analysis plan to clinically evaluate the aBSI was prospectively defined and locked before unmasking of the 10TASQ10 study. The analysis of aBSI was conducted between May 25, 2016, and June 3, 2017. Main Outcomes and Measures The associations of baseline aBSI with OS, radiographic progression-free survival (rPFS), time to symptomatic progression, and time to opiate use for cancer pain. Results Of the total 1245 men enrolled, 721 were evaluable for the aBSI. The mean (SD) age (available for 719 men) was 70.6 (8.0) years (age range, 47-90 years). The aBSI population was representative of the total study population based on baseline characteristics. The aBSI (median, 1.07; range, 0-32.60) was significantly associated with OS (hazard ratio [HR], 1.20; 95% CI, 1.14-1.26; P < .001). The median OS by aBSI quartile (lowest to highest) was 34.7, 27.3, 21.7, and 13.3 months, respectively. The discriminative ability of the aBSI (C index, 0.63) in prognosticating OS was significantly higher than that of the manual lesion counting (C index, 0.60) (P = .03). In a multivariable survival model, a higher aBSI remained independently associated with OS (HR, 1.06; 95% CI, 1.01-1.11; P = .03). A higher aBSI was also independently associated with time to symptomatic progression (HR, 1.18; 95% CI, 1.13-1.23; P < .001) and time to opiate use for cancer pain (HR, 1.21; 95% CI, 1.14-1.30; P < .001). Conclusions and Relevance To date, this investigation is the largest prospectively analyzed study to validate the aBSI as an independent prognostic imaging biomarker of survival in mCRPC. These data support the prognostic utility of the aBSI as an objective imaging biomarker in the design and eligibility of clinical trials of systemic therapies for patients with mCRPC. Trial Registration ClinicalTrials.gov Identifier: NCT01234311.
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Affiliation(s)
- Andrew J Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina.,Division of Urology, Department of Surgery, Duke Cancer Institute, Duke University, Durham, North Carolina.,Department of Pharmacology and Cancer Biology, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Aseem Anand
- EXINI Diagnostics AB, Lund, Sweden.,Division of Urological Cancers, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lars Edenbrandt
- EXINI Diagnostics AB, Lund, Sweden.,Department of Nuclear Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Anders Bjartell
- Division of Urological Cancers, Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | - Cora N Sternberg
- San Camillo Hospital, Rome, Italy.,Forlanini Hospital, Rome, Italy
| | - Roberto Pili
- Indiana University School of Medicine, Indianapolis
| | | | - Örjan Nordle
- Nordle Biostatistical Consultancy, Rydebäck, Sweden
| | | | - Michael J Morris
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medicine, New York, New York
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Hardcastle N, Hofman MS, Lee CY, Callahan J, Selbie L, Foroudi F, Shaw M, Chander S, Lim A, Chesson B, Murphy DG, Kron T, Siva S. NaF PET/CT for response assessment of prostate cancer bone metastases treated with single fraction stereotactic ablative body radiotherapy. Radiat Oncol 2019; 14:164. [PMID: 31488175 PMCID: PMC6728984 DOI: 10.1186/s13014-019-1359-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/16/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction In prostate cancer patients, imaging of bone metastases is enhanced through the use of sodium fluoride positron emission tomography (18F-NaF PET/CT). This imaging technique shows areas of enhanced osteoblastic activity and blood flow. In this work, 18F-NaF PET/CT was investigated for response assessment to single fraction stereotactic ablative body radiotherapy (SABR) to bone metastases in prostate cancer patients. Methods Patients with bone metastases in a prospective trial treated with single fraction SABR received a 18F-NaF PET/CT scan prior to and 6 months post-SABR. The SUVmax in the tumour was determined and the difference between before and after SABR determined. The change in uptake in the non-tumour bone was also measured as a function of the received SABR dose. Results Reduction in SUVmax was observed in 29 of 33 lesions 6 months after SABR (mean absolute decrease in SUVmax 17.7, 95% CI 25.8 to − 9.4, p = 0.0001). Of the three lesions with increased SUVmax post-SABR, two were from the same patient and located in the vertebral column. Both were determined to be local progression in addition to one fracture. The third lesion (in a rib) was shown to be controlled locally but suffered from a fracture at 24 months. Progression adjacent to the treated volume was observed in two patients. The non-tumour bone irradiated showed increased loss in uptake with increasing dose, with a median loss in uptake of 23.3% for bone receiving 24 Gy. Conclusion 18F-NaF PET/CT for response assessment of bone metastases to single fraction SABR indicates high rates of reduction of osteoblastic activity in the tumour and non-tumour bone receiving high doses. The occurrence of marginal recurrence indicates use of larger clinical target volumes may be warranted in treatment of bone metastases. Trial registration POPSTAR, ‘Pilot Study of patients with Oligometastases from Prostate cancer treated with STereotactic Ablative Radiotherapy’, Universal Trial Number U1111-1140-7563, Registered 17th April 2013. Electronic supplementary material The online version of this article (10.1186/s13014-019-1359-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia. .,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Michael S Hofman
- Division of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Ching-Yu Lee
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Jason Callahan
- Division of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Lisa Selbie
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Farshad Foroudi
- Olivia Newton-John Cancer & Wellness Centre
- Austin Health, 145 Studley Road, PO Box 5555, Heidelberg, 3084, Australia
| | - Mark Shaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Sarat Chander
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Andrew Lim
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Brent Chesson
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Declan G Murphy
- Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3000, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3000, Australia
| | - Shankar Siva
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3000, Australia
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10
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Uemura K, Miyoshi Y, Kawahara T, Ryosuke J, Yamashita D, Yoneyama S, Yokomizo Y, Kobayashi K, Kishida T, Yao M, Uemura H. Prognostic value of an automated bone scan index for men with metastatic castration-resistant prostate cancer treated with cabazitaxel. BMC Cancer 2018; 18:501. [PMID: 29716525 PMCID: PMC5930579 DOI: 10.1186/s12885-018-4401-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/18/2018] [Indexed: 12/25/2022] Open
Abstract
Background A computer-assisted diagnostic system for analyzing bone scans (BONENAVI) calculates the automated bone scan index (aBSI). Here we evaluated the aBSI as a prognostic imaging biomarker for men with metastatic castration-resistant prostate cancer (mCRPC) treated with cabazitaxel. Methods We retrospectively analyzed 48 patients who received cabazitaxel for mCRPC and evaluated the ability of the aBSI to predict overall survival (OS). The Cox proportional hazards model was used to investigate the associations between baseline aBSI at cabazitaxel treatment and OS with the clinical variables as follows: age, number of cycles of docetaxel, serum prostate-specific antigen, hemoglobin (Hb), lactate dehydrogenase (LDH), and alkaline phosphatase. We determined the C-index to evaluate the discriminatory ability of our models when we included or excluded the aBSI from the analyses. Results The median OS after cabazitaxel treatment was 10.0 months, and patients with aBSI ≤1% achieved significantly longer OS compared with patients with aBSI ≥1%. Multivariate analysis showed that age, Hb, LDH, and aBSI were independent prognostic factors of OS. Adding aBSI to the base model increased the C-index from 0.78 to 0.80. Conclusions The aBSI may serve as a useful imaging biomarker for predicting OS among men with mCRPC treated with cabazitaxel. Prospective studies are required to establish the value of aBSI as prognostic imaging biomarker.
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Affiliation(s)
- Koichi Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 2320024, Japan.,Department of Urology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Yasuhide Miyoshi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 2320024, Japan.
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 2320024, Japan
| | - Jikuya Ryosuke
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 2320024, Japan
| | - Daisuke Yamashita
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 2320024, Japan
| | - Shuko Yoneyama
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 2320024, Japan
| | - Yumiko Yokomizo
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 2320024, Japan
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11
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Li D, Lv H, Hao X, Dong Y, Dai H, Song Y. Prognostic value of bone scan index as an imaging biomarker in metastatic prostate cancer: a meta-analysis. Oncotarget 2017; 8:84449-84458. [PMID: 29137438 PMCID: PMC5663610 DOI: 10.18632/oncotarget.19680] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/30/2017] [Indexed: 12/27/2022] Open
Abstract
Background The prognostic value of the bone scan index (BSI) in metastatic prostate cancer (mPCa) remained controversial. Therefore, we performed a meta-analysis to determine the predictive value of BSI and survival in patients with mPCa. Materials and Methods A literature search was performed in PubMed, Embase, Web of Science and Cochrane library databases. Hazard ratios (HRs), concordance indices (C-indices) were extracted to estimate the relationship between BSI and survival in patients with mPCa. Subgroup analyses were conducted on different types of mPCa, ethnics, cut-off values and sample sizes. Results 14 high quality studies involving 1295 patients with mPCa were included in this meta-analysis. The pooled results indicated that high basline BSI and elevated BSI change on treatment (ΔBSI) were significantly predictive of poor overall survial (HR = 1.29, P < 0.001; HR = 1.27, P < 0.001, respectively). Baseline BSI was also significantly related to cancer specific survival (HR = 1.65, P = 0.019) and prostate specific antigen recurrence survival (HR = 2.26, P < 0.001). Subgroup analysis supported main results. Moreover, BSI could increase the C-indices of predictive models. Conclusions Baseline BSI and ΔBSI may be beneficial to mPCa prognosis in clinical monitor and treatment. Further high quality studies with larger sample size are required in the future.
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Affiliation(s)
- Dongyang Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Hang Lv
- Department of Urology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, Liaoning 110042, P.R. China
| | - Xuanyu Hao
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110022, P.R. China
| | - Yudi Dong
- Department of Medical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Huixu Dai
- Department of Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yongsheng Song
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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