<p><strong> </strong><strong>In mCRPC patients, clinicians should obtain baseline labs (e.g., PSA, testosterone, LDH, Hgb, alkaline phosphatase level) and review location of metastatic disease (lymph node, bone, visceral), disease-related symptoms, and performance status to inform discussions of prognosis and treatment decision-making. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>There are established laboratory and imaging characteristics known to be associated with prognosis among men with mCRPC. As such, it is recommended that a baseline laboratory and imaging assessment be performed to inform discussions around prognosis and clinical decision-making. Known laboratory risk-factors associated with increasing risk of mortality include elevated LDH, testosterone <20 to 50ng/dL, higher PSA, and shorter PSADT.<sup>9, 36, 37, 114, 115</sup><sup> </sup>There are established imaging findings also known to be associated with increasing risk of mortality.<sup>116</sup> Increasing burden of metastatic disease in the form of the number of metastatic sites is associated with increasing risk of overall mortality. Additionally, there are known relationships between location of metastases and risk of mortality.<sup>117</sup> Specifically, visceral metastases are known to portend the highest risk of mortality (HR=1.76; 95% CI: 1.34 to 2.32 versus lymph node) followed by bone metastases (HR=1.52; 95% CI: 1.20 to 1.93 versus lymph node).<sup>118</sup></p>
<p>In addition to laboratory and imaging parameters, performance status and the extent of disease-related symptoms are strongly associated with mortality. Numerous studies have characterized the inverse relationship between performance status and risk of mortality.<sup>36, 116, 119</sup><sup> </sup> Independently, prostate cancer-related pain is known to be strongly associated with the risk of mortality.<sup>38</sup> Men with mCRPC represent a heterogeneous group with a wide distribution of disease-related symptoms. Given the known relationships between disease-related symptoms and prognosis, it is incumbent upon the treating clinician to perform a thorough symptom inventory at the time of assessment to ensure adequate symptom management and to incorporate the individual patient’s symptom burden into discussions around prognosis and treatment selection.</p>