Prostate Ca: Site of metastases impacts prognosis

Findings from a recent study emphasize the need for imaging with CT or MRI and bone scan to determine the pattern of spread in men with advanced prostate cancer.

In a study of 8,820 men with metastatic castration-resistant prostate cancer (mCRPC), researchers found the prognosis differs substantially based on where the cancer has spread.

Dr. ArmstrongSpread to the liver is associated with shorter survival than lung and bone spread, and patients with lymph node metastases only have the best overall survival, according to co-author Andrew Armstrong MD, ScM, of Duke Cancer Institute, Durham, NC.

“This study may help in risk stratification and decision making around the need for chemotherapy or future clinical trials,” Dr. Armstrong told Urology Times.

Prior reports suggesting the site of metastasis is an important predictor of overall survival of men with metastatic prostate cancer were based on a limited number of patients. This new study is based on a substantial sample of men who received docetaxel (Taxotere) chemotherapy in nine phase III trials, according to the study’s abstract.

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The authors categorized the sites of metastases as lymph node only, bone with or without lymph node (with no visceral metastases), any lung metastases (but no liver), and any liver metastases.

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They found that more than 72% of those studied had bone with or without lymph node metastases, 9.1% had lung metastases, 8.6% had liver metastasis, and 6.4% had lymph node-only disease.

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The highest median survival of about 32 months occurred in the lymph node-only group. Overall median survival for the majority who had bone metastases was just over 21 months. Men with lung metastases had a median survival of 19 months. And men with liver metastasis fared the worst with a median survival of nearly 14 months.

Next: Findings point to importance of imaging to determine pattern of spread

An important point for urologists is the need for imaging with computed tomography or magnetic resonance imaging and bone scan to determine the pattern of spread in men with advanced prostate cancer, Dr. Armstrong said.

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“As this may change over time as well, repeat imaging is recommended over time as the cancer responds or relapses,” he said.

Lead author Susan Halabi, PhD, said in a press release about the study that the information could be used to help guide treatment approaches using either hormonal therapy or chemotherapy.

“These results should help guide clinical decision-making for men with advanced prostate cancer,” Dr. Halabi said. “They also suggest that prognostic subgroups should be considered for investigational therapies that are tested in clinical trials.”