Osteosclerotic changes on computed tomography predict disease progression and poor survival in prostate cancer with osteoblastic metastases

Radiographic progression-free survival (rPFS) in prostate cancer (PC) may not always accurately reflect tumor progression. However, the prognostic significance of osteosclerotic changes (OCs) in PC remains unclear. A training cohort of 152 PC patients with osteoblastic metastases was recruited from the S Cancer Center, while a validation cohort of 41 patients was obtained from two additional hospitals. Patients were stratified into two groups based on computed tomography (CT) findings: those with OCs and those without OCs (no osteosclerotic change, NOC). Clinical outcomes were subsequently analyzed. In the training cohort, 103 and 49 patients were classified into the OC and NOC groups, respectively. A significantly higher proportion of radiographic progression was observed in the OC group than in the NOC group (72.8% vs. 51.0%, P = 0.0105). The OC group demonstrated significantly worse rPFS and overall survival (OS) than the NOC group (median rPFS: 11.6 months vs. 52.9 months, P<0.0001, median OS: 30.7 months vs. 67.1 months, P<0.0001). Multivariate analysis identified OC as an independent prognostic factor for poor rPFS and OS. The results were validated in an external cohort. OCs are associated with adverse survival outcomes and may serve as potential biomarkers for disease progression and reduced survival in PC patients with osteoblastic metastases.