Bone Marrow Biopsy: RNA Isolation with Expression Profiling in Men with Metastatic Castration-resistant Prostate Cancer—Factors Affecting Diagnostic Success

Abstract

In men with mCRPC, percutaneous sampling of osseous metastases for genomic profiling is possible, but use of zoledronic acid for more than 1 year may reduce the yield of adequate tissue for RNA isolation. Sampling large low-attenuating lesions at their periphery maximizes yield.

Imaging, procedural and clinical variables associated with tumor yield on bone biopsy in metastatic castration-resistant prostate cancer

“…Based on prior studies, we predicted that sclerotic lesions would result in lower yield. (8, 11-14) Though we did not show a statistically significant correlation between attenuation and tumor yield, likely related to the small sample size of this cohort, lesions with greater attenuation (>400 HU) did have decreased PPC. In a retrospective analysis of 410 CT-guided biopsies of osseous lesions, imaging appearance was associated with biopsy accuracy (accuracy for sclerotic, lytic, or mixed lytic-sclerotic was 76%, 93%, and 92%, respectively).…”

“…A previous study demonstrated that peripheral lesion sampling may be associated with increased yield (78% versus 52% for peripheral versus central sampling, p=0.24). (8)…”

“…In a prior analysis, zoledronic acid therapy for ≥1 year resulted in a decreased number of positive bone biopsies (50%) compared to patients who did not receive therapy or received <1 year of treatment (74%) (p=0.27). (8) The direct effect of osteoclast-targeting agents in patients undergoing bone biopsy needs to be further explored.…”

“…(7) Another study of 31 men with mCRPC undergoing 54 image-guided biopsies showed that 67% of samples were positive by histology. (8)…”

Castration-Resistant Prostate Cancer Tissue Acquisition From Bone Metastases for Molecular Analyses

“…Technological advances in the processing of tissue from bone biopsies has enabled the performance as a valid approach for tissue acquisition from these patients 14 . Moreover, DNA and RNA sequencing from bone biopsy specimens is now technically feasible 15 . Such biopsies are being increasingly undertaken and even mandated in clinical trials.…”