Metastatic pattern with mild prognostic impact in high-volume castration-sensitive prostate cancer

We aimed to investigate the prognostic impact of the extent of bone metastasis (BM) and lung metastasis (LM) in patients with high-volume (HV) castration-sensitive prostate cancer (CSPC). We retrospectively reviewed 379 patients with synchronous metastatic CSPC, focusing on BM patterns, with and without LM. According to the CHAARTED criteria, 115 and 264 patients were respectively classified as having low-volume (LV) disease with BM of extent of disease 1 (LV-EOD1) and HV disease with BM of EOD 1 to 4 (HV-EOD1-4; 197 with BM alone and 67 with BM plus LM). We compared overall survival (OS) between the LV-EOD1 and HV-EOD1-4 groups after propensity score matching (PSM). We used multivariate Cox regression analysis to assess the risk factors for OS in HV-EOD1-4 patients. There was no significant difference in the OS between LV-EOD1 group and HV-EOD ≤ 2 group (in patients with BM alone or after adding patients with BM plus LM) after PSM. A multivariate analysis for OS in HV-EOD1-4, including LM, demonstrated that EOD ≥ 3 and Gleason score ≥ 9 were independent risk factors, and LM had no significant role. Therefore, HV-EOD ≤ 2, regardless of LM, has a prognostic impact comparable to that of LV-EOD1.