Osteolytic or mixed bone metastasis is not uncommon in patients with high-risk prostate cancer

Purpose: Osteolytic or mixed bone metastases (BMs) are considered rare in prostate cancer (PCa). However, we hypothesized that they are not uncommon in high-risk PCa. This study aimed to compare the clinical and CT imaging characteristics of PCa by focusing on BMs among patients with Gleason score (GS) >= 8 (high-risk group) and those with GS < 7 (intermediate-low-risk group).Methods: Between 2014 and 2021, patients with pathologically proven PCa and no history of other malignancies were included. Clinical findings including age and prostate-specific antigen (PSA) were collected. CT imaging findings, including the types of BM and other metastases, were evaluated by two radiologists. The clinical and CT imaging findings were compared between the high-and intermediate-low-risk groups.Results: Patients were classified into high-risk (n = 527) and intermediate-low-risk (n = 973) groups. Age at diagnosis (median: 71 [44-91] vs 69 [35-86] years, p < 0.0001), PSA (8.7 [0.01-15314.5] vs 5.8 [0.01-163.2] ng/mL, p < 0.0001), frequencies of BMs (osteoblastic: 47/527 [8.7%] vs 3/973 [0.3%]), osteolytic or mixed BM (19/527 [3.6%] vs 2/973 [0.2%]), lymph node metastases (76/527 [14.4%] vs 3/973 [0.3%]), and lung me-tastases (13/527 [2.5%] vs 0%) were significantly higher in the high-risk group than in the intermediate-low-risk group (all p < 0.0001).Conclusions: Age, PSA, and the frequencies of osteolytic or mixed BMs were significantly higher in the high-risk group than in the intermediate-low-risk group. This study highlights the importance of high-risk PCa in the differential diagnoses of osteolytic or mixed BMs.

Automated summary

This study compares the clinical and CT imaging characteristics of prostate cancer patients with high-risk and intermediate-low-risk groups, focusing on bone metastases. The high-risk group shows significantly higher age, PSA levels, and frequencies of osteolytic or mixed bone metastases. This highlights the importance of considering high-risk prostate cancer in the differential diagnosis of bone metastases.