Soft-tissue metastases are found in a relatively high proportion of men with castration-resistant prostate cancer (CRPC) undergoing computed tomography (CT) at the initial diagnosis of metastases, including some patients who have no bone involvement, according to researchers.

A team led by Stephen J. Freedland, MD, of Cedars-Sinai Medical Center in Los Angeles, studied 232 men with non-metastatic CRPC who developed metastatic disease detected by bone scan or CT. The researchers reviewed all bone scans and CT scans within the 30 days before or after mCRPC diagnosis.

Compared with the 118 patients undergoing CT, the 114 patients undergoing bone scans only were significant more likely to have received primary treatment, Dr. Freedland his colleagues reported online ahead of print in Cancer. Among men undergoing CT, 52 (44%) had soft-tissue metastases, including 20 visceral metastases (17%) and 41 lymph node metastases (35%); 30% had no bone involvement.

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A higher PSA level was associated with a significantly increased risk of lymph node metastases, whereas receiving primary treatment was associated with a significantly decreased risk, according to Dr. Freedland’s group. The investigators found no significant predictors of visceral metastases.

The authors concluded that “forgoing CT during a metastatic evaluation may lead to an underdiagnosis of soft-tissue metastases and an underdiagnosis of metastases in general.”