DCSIMG

A rising PSA despite ADT indicates risk for bone metastases and skeletal consequences1,2

Prostate cancer progression

Prostate cancer progression

Once patients on ADT become castration resistant, they are at a greater risk for the development of bone metastases and skeletal-related events (SREs).1-4

Metastases can go undetected and proactive screening is important in appropriate patients

A phase 3 study attempting to enroll patients with nonmetastatic castration-resistant prostate cancer (CRPC) recently reported that an unexpectedly high number of patients failed screening—32% of these patients had to be excluded because scans revealed they had metastatic CRPC5*

Of patients with metastatic CRPC, up to 90% have bone metastases6-8†


*Data from an analysis of all patients screened (N = 2,577) for a randomized, multicenter, placebo-controlled study of zibotentan in patients with nonmetastatic CRPC.

† Data from 3 separate studies analyzing the presence of bone metastases in patients with CRPC.



Given the prevalence of bone metastases in CRPC patients, it is important to identify patients early

Risk factors for metastasis to bone include:

Risk factor Rate of positive bone scan10‡
PSA >10 ng/mL9,10 >60%
PSA doubling time < 9 months10 >40%

‡Data from a retrospective analysis of bone scans from 114 patients receiving ADT after biochemical recurrence following radical prostatectomy.

References

  1. Smith MR, Cook R, Lee KA, Nelson JB. Disease and host characteristics as predictors of time to first bone metastasis and death in men with progressive castration-resistant nonmetastatic prostate cancer. Cancer. 2011;117:2077-2085.

  2. Yin JJ, Pollock CB, Kelly K. Mechanisms of cancer metastasis to the bone. Cell Res. 2005;15:57-62.

  3. Saad F, Gleason DM, Murray R, et al; Zoledronic Acid Prostate Cancer Study Group. Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. J Natl Cancer Inst. 2004;96:879-882.

  4. Ibrahim A, Scher N, Williams G, et al. Approval summary for zoledronic acid for treatment of multiple myeloma and cancer bone metastases. Clin Cancer Res. 2003;9:2394-2399.

  5. Yu EY, Miller K, Nelson J, et al. Detection of previously unidentified metastatic disease as a leading cause of screening failure in a phase III trial of zibotentan versus placebo in patients with nonmetastatic, castration resistant prostate cancer. J Urol. 2012;188:103-109.

  6. Scher HI, Morris MJ, Kelly WK, Schwartz LH, Heller G. Prostate cancer clinical trial end points: "RECIST"ing a step backwards. Clin Cancer Res. 2005;11:5223-5232.

  7. Tannock IF, de Wit R, Berry WR, et al; TAX 327 Investigators. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351:1502-1512.

  8. Petrylak DP, Tangen CM, Hussain MH, et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med. 2004;351:1513-1520.

  9. Smith MR, Kabbinavar F, Saad F, et al. Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer. J Clin Oncol. 2005;23:2918-2925.

  10. Moreira D, Aronson W, Terris M, et al. Does being on ADT alter the ability of PSA and PSADT to predict a positive bone scan? Results from the search database. J Urol. 2010;183(suppl):e335-e336. Abstract 860.