Metastatic prostate cancer at diagnosis: Clinical presentation in the post-PSA era

Abstract

e16159 Background: Prostate cancer (CaP) has varying biologic behavior. Prostate-specific antigen (PSA) screening dramatically diminished the presentation of patients (pts) with metastatic CaP from 5.6% in 1990 to 1.5% in 2003 as evidenced by the CaPSURE database. Our institution has a uniquely diverse demographic and socioeconomic population and we sought to identify pts with metastatic CaP at diagnosis to evaluate contributing factors. Methods: We retrospectively reviewed all pts charts diagnosed with CaP as identified by ICD-9 code (185) between January 1st 2003 and October 31st 2008 after cross referencing with the term metastatic. Pts progressing from localized disease were excluded. Data was collected on pts initially presenting with metastases. Results: Sixty-one pts presented initially with metastatic CaP at a median age of 68 years old (45 –90) and a median PSA of 92 ng/mL (4.4 –3463). Digital rectal exam was normal in 8 pts (13%) and abnormal in 43 (70%). Median body mass index was 27.2 (16.9 –46.7) with 26 pts (42%) being smokers and 20 (32%) non-smokers. Thirty-six pts (59%) had a Charlson Comorbidity Index score of 0, 10 (16%) a score of 1, 10 (16%) a score of 2, and 5 (8%) a score of ≥ 3. Fifteen pts (24%) were Caucasian, 42 (68%) black [24 (39%) African American, 10 (16%) Caribbean, 8 (13%) African], 1 (1%) Hispanic, 1 (1%) Asian, 1 (1%) Albanian, and 1 (1%) Indian. Presenting symptoms were comprised of 32 pts (52%) with lower urinary tract symptoms including hematuria, urinary retention, and hydronephrosis, 21 (34%) with bone pain, 3 (4%) with neurologic deficits, and 17 (27%) were asymptomatic. Forty-seven pts (77%) underwent prostate biopsy of which 33 (70%) had high grade (Gleason ≥ 8) tumor. Conclusions: CaP initially presenting as metastatic disease is a rare event in the post-PSA era, but may result from lacking primary health care screening, poor patient compliance, or inherent predisposing factors of tumor biology. Our analysis identifies a predominantly non-Caucasian population of patients, contrasting the CaPSURE database, who are otherwise healthy. We plan on performing comprehensive analyses on all patients with metastatic CaP at Boston Medical Center. No significant financial relationships to disclose.