Development of a predictive model for progression to castration-resistant prostate cancer in patients with high bone tumor burden.

Abstract

Objective: To identify key risk factors and construct a predictive model for the progression of high bone tumor burden prostate cancer (HBTB-PCa) to castration-resistant prostate cancer (CRPC).

Methods: This retrospective study included 367 HBTB-PCa patients treated between January 2018 and May 2021, with 286 cases progressed to CRPC (progression group) and 81 cases did not (non-progression group). Patients were randomly divided into training (n=257) and validation (n=110) sets at a 7:3 ratio. Logistic regression was used to identify independent risk factors, and a Nomogram was built to predict progression risk. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results: Compared with the non-progression group, patients in the progression group had significantly higher rates of perineural invasion (P=0.011), Gleason score ≥8 (P=0.002), and T4 stage (P=0.012). Laboratory markers including ALP (P<0.001) and LDH (P<0.001) were also elevated in the progression group. Multivariate analysis identified perineural invasion (P=0.032), Gleason score (P=0.002), initial PSA (P=0.025), ALP (P=0.011), LDH (P<0.001), and ALB (P=0.019) as independent predictors of progression to CRPC. The Nomogram demonstrated strong discrimination power (AUC=0.845 in the training set; AUC=0.746 in external validation), with LDH being the most influential predictor. DCA indicated a net clinical benefit up to 77.82%.

Conclusions: Perineural invasion, Gleason score ≥8, and elevated ALP and LDH are closely associated with progression from HBTB-PCa to CRPC. The constructed Nomogram (internal AUC=0.845; external AUC=0.746) offers a practical tool for individualized risk assessment and guiding treatment planning in clinical settings.