: Prostate cancer presents with soft tissue progression (STP) is highly aggressive. We analyzed the risk factor for STP in patients with metastatic castration-resistant prostate cancer (mCRPC) who developed abiraterone acetate (AA) resistance.
Methods
: This retrospective study included patients with mCRPC who received AA between February 2018 and July 2022. STP was defined as recurrent lesions in situ, multiple regional lymph node metastases (mLNM), or visceral metastases. Clinical features of patients with STP were analyzed, and risk factors for STP were further investigated.
Results
: Sixty-three patients (mean age, 75.0 years; median follow-up time, 22.3 months) were included in this study. Twenty-three patients (36.5%) presented STP during follow up, the overall survival (OS) after STP was 4.6 months. The serum neuron-specific enolase (NSE) were significantly elevated in patients with STP. Biopsies for 8 patients with STP showed neuroendocrine prostate cancer (NEPC, n=5) was the major pathological types. Further analysis showed that perineural invasion (PNI) in primary tumor were the independent risk factors (HR = 3.145, P = 0.020) for STP, and PNI was related to the aggressiveness of tumor. Patients with PNI showed shorter castration-resistant progression free survival (median, 23.73 months vs 25.59 months) and STP progression free survival (median, 19.7 months vs not reached) compared with patients without PNI.
What should I make of this study, which describes me?
My MRI showed perineurial invasion (PNI). It has spread to soft tissue (nodes in pelvis and abdomen). It has not spread to bones. I have been on Abiraterone for 4 months. When I become castrate-resistant (CR) to Abiraterone, the study indicates that soft tissue progression (STP) will be fast.
Does the study say that PNI makes STP faster after CR, or that Abiraterone causes this? Should I change from Abiraterone to Erleada or Xtandi to reduce STP after CR?
Will do. But how do you or others read that study?
Does the study say that perineural invasion makes soft tissue progression go faster after castrate resistance, or that Abiraterone is needed to cause this? I wonder why the study just looked at Abiraterone users?
STP showed extremely poor prognoses in patients with mCRPC after AA resistance, NEPC is the main pathological type of STP, and PNI in primary tumor was an independent risk factor for STP and indicated poor prognosis of prostate cancer
I get that PNI in primary tumor has a bad prognosis, but what is the role of Abiraterone in this? The study just used Abiraterone users. I wonder if the same thing would have happened after castrate resistance to any of the other drugs.
I think you mean that Abiraterone does work but has a bad effect after it doesn't. With initial perineurial invasion, and after resistance happens with Abiraterone, it allows faster soft tissue progression than any other drug would.
Many people have used Abiraterone since its introduction over ten years ago, for many years with good PSA suppression. But the problem occurs after the inevitable castrate resistance occurs.
This is very scary to me! My husband had a BCR and clinical progression for Stage 3b, Gleason 9 prostate cancer this past November. He was found to have four sub centimeter PSMA avid nodes in his abdomen (retrocaval).. He was offered Lupron and AA/prednisone. Now I worry that we should remove the AA and just use Lupron instead , and if the psa rises, use Docetaxel and another type of ARSI such as Xtandi or even the Apalutamide. I don’t know what to think?
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