Prognostic value of soft tissue metastasis (STM) in stage D2 and stage D3 prostate Cancer (PC).

4720 Purpose: The extent of bone involvement is a known predictor of survival in D2 PC. This study aims to determine the prognostic value of STM (lymphadenopathy or visceral) diagnosed by CT scan during the progression from stage D2 to D3 PC.,We reviewed records of 205 pts with stage D2 PC and followed them thru stage D3 to death. All pts were castrated and followed at 3 month intervals. The following variables were extracted at time of D2: Gleason score (GS), Hemoglobin (HGB), LDH, Alkaline Phosphatase (ALK), PSA, bone scan (BSD2), CT scan (CTD2), race. At time of D3, we documented status of bone scan (BSD3), CT scan (CTD3), and chemotherapy administration. A 50% reduction in D2 PSA (PSA50) and the doubling time (PSADT) of PSA nadir after castration were determined. Cox proportional hazards models and log rank survival test were performed.,Median (M) age of 70 years (53-91) and M GS of 7 (6-10). At D2, the M HGB was 13.1 g/dl(5.0-17.3), LDH 193 IU/L(85-1239), ALK 136.5 U/L(43-2007) and PSA was 157 ng/ml(1.4-14,096). Positive BSD2 and CTD2 were seen in 84.2% and 55.8% of pts, respectively. PSA50 was achieved by 92.0% of pts and M PSADT was 5.6 months (mos) (.8-41.5). There was a trend towards improved survival with a negative CTD2 (p=.07). Besides known D2 survival predictors HGB (Hazard Ratio (HR) =0.82, p=0.04), GS (HR =1.4, p=0.005), LDH (HR=1.0, p=0.003), PSADT (HR=0.80, p=0.01), the addition of CTD3 information was an additional independent predictor of D2 survival (HR 2.84, p=0.009). Patterns of CTD2 and CTD3 findings were independent predictors of D2 survival (HR1.67, p=.025).,The significance of soft tissue metastases is best appreciated by taking a longitudinal view of CT scan findings at both D2 and D3. The evolution of STM from stage D2 to stage D3 PC is an independent predictor of survival. A larger study is needed to confirm these results. [Figure: see text] No significant financial relationships to disclose.