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Predictors of Prostate Cancer Tissue Acquisition by an Undirected Core Bone Marrow Biopsy in Metastatic Castration-Resistant Prostate Cancer—A Cancer and Leukemia Group B Study

Authors' Affiliations: ¹ Dana-Farber Cancer Institute, Boston, Massachusetts; ² Duke University Medical Center, Durham, North Carolina; ³ University of Massachusetts Medical School, Worcester, Massachusetts; ⁴ University of Chicago Medical Center, Chicago, Illinois; and ⁵ University of California at San Francisco, San Francisco, California

Requests for reprints: Robert W. Ross, Dana-Farber Cancer Institute, Smith 353 44 Binney Street, Boston, MA 02115. Phone: 617-632-3237; Fax: 617-632-2165; E-mail: rwross{at}partners.org.

Purpose: Analyzing metastatic prostate cancer tissue is of considerable importance in evaluating new targeted agents, yet acquiring such tissue presents a challenge due to the predominance of bone metastases. We assessed factors predicting a successful tumor harvest from bone marrow biopsies (BMBx) in castration-resistant metastatic prostate cancer patients.

Material and Methods: Data from Cancer and Leukemia Group B study 9663 were reviewed. Bone marrow biopsies were obtained from 184 patients who underwent an office-based, unguided bone marrow biopsy of the posterior iliac crest.

Results: Forty-seven of the 184 patients (25.5%) had a positive bone marrow biopsy. When considered in a multivariate logistic regression analysis, lower hemoglobin levels, higher alkaline phosphatase, and higher lactate dehydrogenase levels were associated with a higher likelihood of a positive BMBx. The median survival time was 11 months (95% confidence interval, 8.0-14) among patients with a positive BMBx compared with 23 months (95% confidence interval, 19-27) with a negative BMBx. The median time to progression and time to prostate-specific antigen progression-free survival were also significantly decreased among positive BMBx patients. No patients with a positive BMBx survived beyond 3 years, whereas 11 of the 137 patients with a negative BMBx survived beyond 5 years.

Discussion: Using common laboratory values, a specific patient cohort can be defined from whom the yield of a nonguided BMBx would be high enough to justify this approach. For studies that require broader entry criteria, a more directed approach with image guidance is recommended.