Practice Patterns and Predictors of Followup Imaging after a Negative Bone Scan in Men with Castration Resistant Prostate Cancer: Results from the SEARCH Database

Amling

et al. 2016

Cancer

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The lack of racial differences in the development of metastases and scanning practices observed in this study suggests that, once men have a diagnosis of M0/Mx CRPC, race may not be a prognostic factor. Efforts to understand prostate cancer racial disparities may derive greater benefit by focusing on the risk of developing prostate cancer and on the outcomes of men who have early stage disease. Cancer 2016;122:3848-3855. © 2016 American Cancer Society.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Race does not predict the development of metastases in men with nonmetastatic castration‐resistant prostate cancer

Whitney¹,

Amling

et al. 2016

Cancer

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“…We defined castration as a testosterone level < 50 ng/dL, bilateral orchiectomy, or the continuous receipt of a luteinizing hormone–releasing hormone agonist or antagonist. Detailed methods on the selection of our population have been published previously . We collected information on demographic, clinical, and pathological characteristics as well as all imaging after the CRPC diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…Detailed methods on the selection of our population have been published previously. 17 We collected information on demographic, clinical, and pathological characteristics as well as all imaging after the CRPC diagnosis. Of the 668 men with M0 CRPC, 457 (68%) had at least 1 imaging test after the diagnosis of M0 CRPC, and 255 of these men (56%) had a positive imaging test for metastases ( Fig.…”

Section: Data Collectionmentioning

confidence: 99%

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

Hanyok¹,

Amling

et al. 2015

Cancer

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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 5 118), men undergoing only bone scans (n 5 114) were more likely to have received primary treatment (P 5.048), were older (P 5.013), and less recently developed metastases (P 5.018). Among those undergoing CT, 52 (44%) had softtissue 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 5.047), 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 5.014), whereas receiving primary treatment was associated with decreased risk (OR, 0.36; P 5.015). 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 2016;122:222-9. V C 2015 American Cancer Society.KEYWORDS: castration-resistant prostatic neoplasms, computed X-ray tomography metastasis, logistic models, prevalence, prostatespecific antigen, soft-tissue neoplasms. INTRODUCTIONBecause bone is the most common site for prostate cancer metastases, bone scans play a central role in a prostate cancer metastatic evaluation. 1 Historically, the presence of metastases outside the bone (ie, soft tissue), including metastases of the visceral organs and distant lymph nodes, was thought to be rare. Recently, there has been a growing awareness of the importance of visceral metastases. This in part stems from the use of new life-prolonging therapies (eg, abiraterone, enzalutamide, and docetaxel) that may alter the biology of prostate cancer and result in increased rates of visceral metastases. 2,3 The detection of visceral metastases as well as distant nodal metastases has 3 important clinical implications. First, the median survival of patients with visceral metastases or a combination of nodal metastases and bone metastases is significantly

“…The most common method of detecting prostate cancer metastases is still a bone scan; however, most bone scans are negative . This also applies to men with M0 CRPC . Given that bone scans are costly and create potential anxiety, it would be ideal to select only high‐risk patients for imaging.…”

Section: Introductionmentioning

confidence: 99%

Validation of a bone scan positivity risk table in non‐metastatic castration‐resistant prostate cancer

Freedland

Hanyok³

et al. 2016

BJU International

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ObjectivesTo test the external validity of a previously developed risk table, designed to predict the probability of a positive bone scan among men with non-metastatic (M0) castrationresistant prostate cancer (CRPC), in a separate cohort. Patients and MethodsWe retrospectively analysed 429 bone scans of 281 patients with CRPC, with no known previous metastases, treated at three Veterans Affairs Medical Centers. We assessed the predictors of a positive scan using generalized estimating equations. Area under the curve (AUC), calibration plots and decision-curve analysis were used to assess the performance of our previous model to predict a positive scan in the current data. ResultsA total of 113 scans (26%) were positive. On multivariable analysis, the only significant predictors of a positive scan were log-transformed prostate-specific antigen (PSA): hazard ratio (HR) 2.13; 95% confidence interval (CI) 1.71-2.66 (P < 0.001) and log-transformed PSA doubling time (PSADT): HR 0.53; 95% CI 0.41-0.68 (P < 0.001). Among men with a PSA level <5 ng/mL, the rate of positive scans was 5%. The previously developed risk table had an AUC of 0.735 to predict positive bone scan with excellent calibration, and provided additional net benefit in the decision-curve analysis. ConclusionWe have validated our previously developed table to predict the risk of a positive bone scan among men with M0/Mx CRPC. Use of this risk table may allow better tailoring of patients' scanning to identify metastases early, while minimizing over-imaging. Regardless of PSADT, positive bone scans were rare in men with a PSA <5 ng/mL.