Prognostic Significance of Radiographic Progression at Metastatic Castration-Resistant Prostate Cancer Diagnosis.

Area of Science:

• Oncology
• Radiology
• Prostate Cancer Research

Background:

• Castration-resistant prostate cancer (CRPC) management often relies on prostate-specific antigen (PSA) kinetics.
• Radiographic progressive disease (rPD) at metastatic CRPC (mCRPC) diagnosis is not consistently assessed, and its prognostic significance is unclear.

Purpose of the Study:

• To investigate the prognostic impact of radiographic progressive disease (rPD) at the time of mCRPC diagnosis on patient survival outcomes.

Main Methods:

• Retrospective analysis of imaging data from 108 mCRPC patients.
• Classification of patients based on the presence or absence of rPD at mCRPC diagnosis.
• Kaplan-Meier and Cox proportional hazards analyses for overall survival (OS) and prostate cancer-specific survival (PCSS).

Main Results:

• 47.2% of patients exhibited rPD at mCRPC diagnosis, associated with poorer prognostic markers.
• Median OS and PCSS were significantly shorter in the rPD-positive group compared to the rPD-negative group (p < 0.001).
• rPD and elevated alkaline phosphatase (ALP) were independent predictors of worse survival.

Conclusions:

• Radiographic progression at mCRPC diagnosis is an independent prognostic factor for reduced survival.
• Relying solely on PSA kinetics may lead to underrecognition of disease progression.
• Regular imaging follow-up is recommended to complement PSA monitoring in mCRPC management.