Prostate Cancer Liver Metastasis: An Ominous Metastatic Site in Need of Distinct Management Strategies

Abstract

Prostate cancer liver metastasis (PCLM), seen in upwards of 25% of metastatic castration-resistant PC (mCRPC) patients, is the most lethal site of mCRPC with a median overall survival of 10-14 months. Despite its ominous prognosis and anticipated rise in incidence due to longer survival with contemporary therapy, PCLM is understudied. This review aims to summarize the existing literature regarding the risk factors associated with the development of PCLM, and to identify areas warranting further research. A literature search was conducted through Ovid MEDLINE from 2000 to March 2023. Relevant subject headings and text words were used to capture the following concepts: "Prostatic Neoplasms", "Liver Neoplasms", and "Neoplasm Metastasis". Citation searching identified additional manuscripts. Forty-one studies were retained for detailed analysis. The clinical risk factors for visceral/liver metastasis included <70 years, ≥T3 tumor, N1 nodal stage, de novo metastasis, PSA >20 ng/mL, and a Gleason score >8. Additional risk factors comprised elevated serum AST, LDH or ALP, decreased Hb, genetic markers like RB1 and PTEN loss, PIK3CB and MYC amplification, as well as numerous PC treatments either acting directly or indirectly through inducing liver injury. Further research regarding predictive factors, early detection strategies, and targeted therapies for PCLM are critical for improving patient outcomes.

Keywords: castration-resistant prostate cancer; liver injury; liver metastasis; risk factors.

Figure 1

Consort diagram for inclusion/exclusion criteria. Four hundred and sixty-four manuscripts were identified through a search Query on Ovid Medline Database. Of these, 379 papers were not found to be relevant to the topic and were excluded. Next, an additional 66 manuscripts were removed for the following reasons: case reports (n = 20), topic was not within the review scope (n = 37), and no full-text documents (n = 9). The remaining 19 articles were thoroughly reviewed for eligibility, and an additional 24 manuscripts identified through citation searching were included to form a total of 43 studies in this review.