Cancer spread to the visceral organs is increasing in prostate cancer

The authors examined how often castration-resistant prostate cancer spreads to the visceral organs of the body.

Castration-resistant cancer occurs when patients eventually become resistant to androgen deprivation therapy (ADT – therapy intended to reduce the production of male sex hormones or inhibit their effect on cancer cell growth) and cancer grows and progresses despite treatment.

Visceral disease involves spread of the cancer to internal organs within the chest (such as the heart or lungs) or in the abdomen (such as the liver, pancreas or gut). Visceral disease was previously considered uncommon in men with castration-resistant prostate cancer. However, with the introduction of several new survival-prolonging treatments, it is thought that more patients will develop visceral involvement, requiring improved recognition and characterisation to improve patient outcome.

The study analysed 442 castration-resistant prostate cancer patients who were enrolled in previous clinical trials. Metastatic disease was present in 54% of these patients. Out of 359 patients who had died, 32% had evidence of visceral metastases (spread of the cancer to the visceral organs) on their last imaging scan. Most patients developed visceral metastasis late in the disease course.

The average interval from cancer diagnosis to development of visceral disease was 4.6 years, while the average interval from development of castration-resistant prostate cancer to development of visceral disease was 1.6 years.

Of those patients with visceral disease, 61.7% had metastasis to the liver, 40.8% to the lung, 11.3% to the peritoneum (the membrane lining the organs inside the abdomen), 9.6% to the adrenal glands (located on top of the kidneys) and 9.6% to the brain. In most patients only one site of visceral disease was identified. Patient outcome differed based on the degree of bone involvement at detection of visceral disease. Those with no evident bone disease had an average survival of 18.2 months compared to 8.1 months in those with moderate bone involvement and 6.1 months in those with more extensive bone involvement.

The authors concluded that their data suggests that metastatic prostate cancer involves the visceral organs commonly, particularly in the advanced stages of disease.