Automated Bone Scan Aids Prognosis in Metastatic Prostate Cancer

NEW YORK (Reuters Health) - In men with metastatic castration-resistant prostate cancer, the automated-bone-scan index (aBSI) is significantly associated with survival, according to a secondary analysis of data from a clinical trial.

As Dr. Andrew J. Armstrong told Reuters Health by email, "In this study, we have validated the aBSI as an objective and quantitative measure of metastatic disease burden in men with prostate cancer, and find that the aBSI is highly associated with clinical outcomes including survival and time to symptomatic progression."

Dr. Armstrong of Duke University, in Durham, North Carolina, and colleagues examined the utility of the aBSI by analyzing baseline score and outcome in 721 participants in a randomized clinical trial of tasquinimod.

The aBSI, which ranged from zero to 32.60 with a median of 1.07, was significantly associated with overall survival (hazard ratio, 1.20). Median OS in the lowest quartile of aBSI was 21.7 months, while in the highest it was 13.3 months, the researchers report in JAMA Oncology, online May 12.

Compared with lesion counting, the discriminative ability of aBSI was significantly higher. Furthermore, in a multivariable survival model, a higher aBSI remained independently associated with OS (HR, 1.06; P=0.03). This was also the case for time to symptomatic progression (HR, 1.18; P<0.001) and time to opiate use for cancer pain (HR, 1.21; P<0.001).

"The aBSI is only moderately or weakly associated with standard clinical biomarkers, such as tumor pain and (lactate dehydrogenase) and (prostate-specific antigen) values, and thus has independent clinical value for determining prognosis and is strongly associated with bone metastatic burden and risk of future bone metastases," the researchers point out.

Dr. Armstrong concluded, "These findings support the clinical utility of this tool to aid clinicians in providing prognostic information to patients but more importantly to design clinical studies of new agents to better measure, target and treat patients with bone metastases."

Dr. Fred Saad the University of Montreal Hospital Center, in Canada, who wrote an accompanying editorial, told Reuters Health by email, "Determining metastatic burden is important for prognosis as well as for judging response or resistance to therapy. This is a challenge when bone is the site of metastases as in prostate cancer."

"Finding reliable automated methods for evaluating bone metastatic burden is critically important in prostate cancer," he said. "The study by Armstrong et al is a large step in the right direction."


JAMA Oncol 2018.



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