Nomogram-based prognostic model construction for progression to castration-resistant prostate cancer in patients with high tumor burden and osseous metastatic prostate cancer.

This study aims to construct a Nomogram model to predict the risk of developing castration-resistant prostate cancer (CRPC) in patients with high tumor burden (HTB) and osseous metastatic prostate cancer (PCa), and to identify key prognostic factors. A retrospective analysis was conducted on patients with HTB and osseous metastatic PCa treated at The Sixth Affiliated Hospital, School of Medicine, South China University of Technology and the Second Affiliated Hospital of Guangzhou Medical University from January 2018 to February 2022. Patients' baseline data and laboratory indexes were collected. Cox regression analysis identified neural invasion (NI; P<0.001, HR: 2.371, 95% CI: 1.569-3.582), Gleason score (P=0.002, HR: 1.787, 95% CI: 1.241-2.573), initial PSA (P=0.004, HR: 1.677, 95% CI: 1.174-2.396), and lactate dehydrogenase (LDH; P<0.001, HR: 2.729, 95% CI: 1.855-4.014) as significant prognostic factors for progression to CRPC. The constructed Nomogram model exhibited high accuracy in predicting one- and two-year progression to CRPC, with external validation confirming its predictive performance. Time-dependent receiver operating characteristic (ROC) curves indicated that the areas under the curves (AUCs) of the model for one- and two-year progression to CRPC were 0.81 and 0.76, respectively. This model demonstrates high predictive performance, aiding clinical decision-making and providing personalized treatment strategies for patients with HTB and osseous metastatic PCa.