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. Issue 2 (20th October 2015) - Hanyok, Brian T.
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. Cancer 2015. © 2015 American Cancer Society . Cancer 2016;122:222–229. © 2015 American Cancer Society . Abstract : This analysis has found a 44% prevalence of soft‐tissue metastases at the diagnosis of metastatic castration‐resistant prostate cancer among patients undergoing a computed tomography scan with or without a bone scan. These data support the routine use of computed tomography for the metastatic evaluation of men with M0 castration‐resistant prostate cancer.