Assessment of Aortoiliac Atherosclerotic Plaque on CT in Prostate Cancer Patients Undergoing Treatment

Abstract

Traditionally, atherosclerotic risk factors for cardiovascular disease and cancer are assessed using coronary artery calcium scoring. However, this neglects the impact of atherosclerotic disease more proximal to the cancer site. This study assesses whether aortoiliac atherosclerotic plaque is associated with prostate cancer. The dataset consisted of abdominopelvic CT of 93 patients with prostate cancer and 186 asymptomatic patients who underwent CT colonography as an age- and gender-matched control group. Agatston scores were measured in the abdominal aorta, common iliac, and internal iliac arteries. The scores were evaluated for associations with age, Framingham risk score, and prostate cancer-related biomarkers, including prostate-specific antigen, Gleason score, tumor location, prostatectomy, androgen deprivation therapy, mortality, and bone metastasis. The atherosclerotic plaque of prostate cancer patients did not differ from the control group (p = 0.22) and was not correlated with any of the prostate cancer-related biomarkers (p > 0.05). However, Agatston scores of abdominal plaques correlated well with age (p < 0.001) and Framingham risk scores (p = 0.002).

Keywords: atherosclerotic plaques; cardiovascular diseases; contrast-enhanced; prostatic cancer.

Figure 1

Flow diagram of study outline. Abbreviations: CECT, contrast-enhanced CT; CTC, CT colonography; AA, abdominal aorta; CIA, common iliac artery; IIA, internal iliac artery.

Figure 2

Example of Agatston score measurement. (left) A 72-year-old male with prostate cancer. Agatston scores for abdominal aorta (AA), common iliac arteries (CIA), and internal iliac arteries (IIA) were 752, 3932, and 506. (right) A 74-year-old asymptomatic male from the control group. Agatston score for AA, CIA, and IIA were 2814, 3265, and 1555. Plaques in AA, CIA, and IIA are colored differently. 3D images are facing anterior to posterior (P).

Figure 3

Agatston scores of Cases and Controls patients in different arterial territories. (a) Agatston scores of Cases patients in different vessels. The median scores were 340 (IQR, 60-930) for the abdominal aorta (AA), 407 (IQR, 178-1064) for the common iliac arteries (CIA), and 92 (IQR, 28-257) for the internal iliac arteries (IIA). Cases scores are before calibration. Only non-zero plaques are included. The violin plots display the full distribution of the data, and the box plots represent the median, upper, and lower quartiles. (b) Agatston scores of Controls patients in different vessels. The median scores were 555 (IQR, 152-2212) for the AA, 349 (IQR, 89-1364) for the CIA, and 208 (IQR, 76-486) for the IIA. Abbreviations: IQR, interquartile range.

Figure 4

Correlation of Agatston scores between different vessels. (a) Correlation of Agatston scores between the abdominal aorta (AA), common iliac arteries (CIA), and internal iliac arteries (IIA) in Cases dataset. (b) Correlation of Agatston scores between the AA, CIA, and IIA in the Controls dataset. The scores were first stratified into quartiles before Spearman’s correlation.