Myosteatosis Predicts Poor Prognosis in Patients With Castration-Resistant Prostate Cancer Treated With Enzalutamide

Area of Science:

• Oncology
• Radiology
• Prognostics

Background:

• Prostate cancer prognostication traditionally relies on tumor characteristics.
• Emerging research indicates host physical factors significantly impact patient outcomes.
• Myosteatosis and sarcopenia are indicators of muscle health with potential prognostic value.

Purpose of the Study:

• To investigate myosteatosis and sarcopenia as prognostic factors in patients with androgen receptor signaling inhibitor-naïve, castration-resistant prostate cancer.
• To determine the association of these physical factors with failure-free survival.
• To evaluate their role in predicting treatment response to enzalutamide.

Main Methods:

• Retrospective analysis of 117 patients with castration-resistant prostate cancer receiving enzalutamide.
• Myosteatosis and sarcopenia assessed via pretreatment abdominal computed tomography.
• Multivariate Cox proportional hazards analysis to identify independent prognostic factors for failure-free survival.

Main Results:

• Myosteatosis was present in 42% and sarcopenia in 39% of patients.
• Univariate analysis showed myosteatosis and distant metastasis associated with shorter failure-free survival.
• Multivariable analysis confirmed myosteatosis as an independent predictor (HR 1.91, p<0.01), with median failure-free survival of 6 months vs. 17 months.

Conclusions:

• Myosteatosis is an independent predictor of failure-free survival in enzalutamide-treated, castration-resistant prostate cancer patients.
• CT-based muscle quality assessment may aid in predicting outcomes for androgen receptor signaling inhibitor therapy.
• Incorporating physical factors like myosteatosis can refine prognostication in advanced prostate cancer.