405 IS 3-MONTHS PROST-TREATMENT RECIST EVALUATION OF BONE METASTASES BY MRI OF THE AXIAL SKELETON (ASMRI) A SURROGATE ENDPOINT FOR PREDICTING OVERALL SURVIVAL (OS) OF PROSTATE CANCER (PCA) PATIENTS?

Abstract

You have accessJournal of UrologyProstate Cancer: Staging III1 Apr 2010405 IS 3-MONTHS PROST-TREATMENT RECIST EVALUATION OF BONE METASTASES BY MRI OF THE AXIAL SKELETON (ASMRI) A SURROGATE ENDPOINT FOR PREDICTING OVERALL SURVIVAL (OS) OF PROSTATE CANCER (PCA) PATIENTS? Bertrand Tombal, Jean-Pascal Machiels, Annabelle Stainier, Bruno Vande Bergh, and Frederic Lecouvet Bertrand TombalBertrand Tombal More articles by this author , Jean-Pascal MachielsJean-Pascal Machiels More articles by this author , Annabelle StainierAnnabelle Stainier More articles by this author , Bruno Vande BerghBruno Vande Bergh More articles by this author , and Frederic LecouvetFrederic Lecouvet More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.474AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Correct evaluation of tumor response in patients with metastatic PCa is confounded by a high frequency of bone metastases. Here we have analyzed whether RECIST criteria calculated on bone metastases using asMRI can be developed as a potential surrogate for OS METHODS We have prospectively enrolled 65 metastatic PCa patients scheduled to received treatment within 2 weeks, including 38 hormone naïve PCa (HNPC) scheduled to receive androgen deprivation therapy (ADT) and 27 castration-resistant PCa (CRPC) scheduled to received docetaxel based chemotherapy. In addition to standard follow-up, asMRI was performed 2 wks before and 3 mths after treatment. RECIST were performed on focal lesions the two sequential asMRI to define complete response (CR), partial response (PR), stable disease (SD) or progression (PROG). PSA is define as drop ≥ 80% in HNPC and ≥ 30% in CRPC. RESULTS Mean OS is 43 (95%CI 32-54) mths in HNPC. PSA drop ≥ 80% occurred in 78% HNPC. This does not predict OS (HR 1,6; 95%CI 0,7-4,1; p=0,271). Only 5 HNPC patients experienced a CR on asMRI, 3 a PR, 7 a SD and 15 a PROG. Progression at 3 months was significantly associated with a shorter OS, 33 (95%CI 20-47) months for PROG vs. 50 (95%CI 39-60) months for CR/PR/SD (p for log-rank: 0,033). The HR of PROG for OS is 2,6; 95%CI 1,1- 6,5; p=0,040). Mean OS is 22 (95%CI 15-28) mths in CRPC. Nineteen (70%) CRPC patients experienced a PSA response ≥ 30%; this does not predict OS (HR 2.1; 95%CI 0.8-5.6: p= 0.105). In patients experiencing a PSA decrease ≥ 30%, asMRI demonstrate CR in only 2 patients, SD in 7 and PROG in 10. In those with a PSA drop < 30%, there were no CR, SD and 6 PROG. Progression at 3 months was significantly associated with a shorter OS, 17 (95%CI 11-23) for PROG vs. 34 (95%CI 21-46) months for CR/PR/SD (p for log-rank: 0,037). The HR of PROG for OS is 2,8; 95%CI 1,0- 8,0; p=0,045) CONCLUSIONS This suggests that RECIST progression in bone metastases, defined by asMRI is of potential interest as a surrogate for OS in clinical trials of metastatic prostate cancer. In addition, no CR or PR were observed in patients presenting with diffuse infiltration of the bone marrow, suggesting a very poor prognostic group in which alternative treatment strategies could be initiated earlier. Brussels, Belgium© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e160-e161 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bertrand Tombal More articles by this author Jean-Pascal Machiels More articles by this author Annabelle Stainier More articles by this author Bruno Vande Bergh More articles by this author Frederic Lecouvet More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...