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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

CT-Defined Osteosarcopenia Is Associated with Mortality in Metastatic Prostate Cancer: A Longitudinal Analysis of Opportunistic CT Imaging

  • Tayler D. Ross1,2,3
  • Saleh Tabatabaei3,4
  • Rose Yakubov4,5
  • Urban Emmenegger2,3,6
  • Cari Whyne1,2,3,4
  • Michael Hardisty1,3,4
6 affiliations
  1. 1Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Toronto, ON M5T 1P5, Canada
  2. 2Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, C. David Naylor Building, 6 Queen’s Park Crescent, Toronto, ON M5S 3H2, Canada
  3. 3Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
  4. 4Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON M5S 3G9, Canada
  5. 5Temerty School of Medicine, Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
  6. 6Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
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Abstract

Background/Objectives: In metastatic prostate cancer, loss of bone density (osteoporosis), muscle quantity and quality (sarcopenia) may contribute to fractures, falls, and mortality. Unfortunately, their longitudinal assessment is poorly characterized. In prostate cancer, ageing, advanced disease, and cancer treatments may accelerate bone and muscle loss. This study assessed longitudinal computed tomography-derived musculoskeletal biomarkers in metastatic prostate cancer and the association between baseline osteosarcopenia and mortality. Methods: This retrospective single-centre cohort included 437 patients, 3595 muscle computed tomography (CT) assessments and 2944 bone CT assessments. An automated deep-learning pipeline quantified lumbar trabecular bone mineral density (BMD), psoas muscle volume (PV), and psoas muscle density. Osteosarcopenia was defined as concurrent osteoporosis (BMD < 135 Hounsfield Units (HU)) and sarcopenia (volumetric psoas muscle index (vPMI) < 30). Patient-aware mixed-effects models characterized biomarker trends and reverse-time analysis. Kaplan–Meier analysis and Cox proportional-hazards regressions were utilized to assess mortality. Results: Baseline osteosarcopenia affected 75 patients (17.2%). Psoas density decreased by 1.569 HU/year (95% confidence interval (CI) −1.703 to −1.434 HU/yr). Nonlinear models estimated mean declines in psoas volume (−6.42 cm3/year) and bone density (−6.01 HU/year). Among deceased patients, modelled final-year declines showed −12.57% in psoas density and −10.28% in psoas volume. Baseline osteosarcopenia was associated with higher all-cause mortality (Hazard Ratio (HR) 1.611; 95% CI 1.134–2.288; p = 0.008). Conclusions: Osteosarcopenia is common and progressive in metastatic prostate cancer, and muscle loss accelerates near death. Baseline osteosarcopenia independently identifies patients at increased mortality risk. CT imaging provides a scalable approach for longitudinal assessment of musculoskeletal health and offers clinically important information without additional patient burden.

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Cite

BibTeXRIS
BibTeX
@article{ross2026ctdefined,
  title = {{CT-Defined Osteosarcopenia Is Associated with Mortality in Metastatic Prostate Cancer: A Longitudinal Analysis of Opportunistic CT Imaging}},
  author = {Tayler D. Ross and Saleh Tabatabaei and Rose Yakubov and Urban Emmenegger and Cari Whyne and Michael Hardisty},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218453},
  url = {https://www.mdpi.com/2077-0383/15/21/8453},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - CT-Defined Osteosarcopenia Is Associated with Mortality in Metastatic Prostate Cancer: A Longitudinal Analysis of Opportunistic CT Imaging
AU  - Tayler D. Ross
AU  - Saleh Tabatabaei
AU  - Rose Yakubov
AU  - Urban Emmenegger
AU  - Cari Whyne
AU  - Michael Hardisty
PY  - 2026
DA  - 2026/10/30
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218453
UR  - https://www.mdpi.com/2077-0383/15/21/8453
AB  - Background/Objectives: In metastatic prostate cancer, loss of bone density (osteoporosis), muscle quantity and quality (sarcopenia) may contribute to fractures, falls, and mortality. Unfortunately, their longitudinal assessment is poorly characterized. In prostate cancer, ageing, advanced disease, and cancer treatments may accelerate bone and muscle loss. This study assessed longitudinal computed tomography-derived musculoskeletal biomarkers in metastatic prostate cancer and the association between baseline osteosarcopenia and mortality. Methods: This retrospective single-centre cohort included 437 patients, 3595 muscle computed tomography (CT) assessments and 2944 bone CT assessments. An automated deep-learning pipeline quantified lumbar trabecular bone mineral density (BMD), psoas muscle volume (PV), and psoas muscle density. Osteosarcopenia was defined as concurrent osteoporosis (BMD < 135 Hounsfield Units (HU)) and sarcopenia (volumetric psoas muscle index (vPMI) < 30). Patient-aware mixed-effects models characterized biomarker trends and reverse-time analysis. Kaplan–Meier analysis and Cox proportional-hazards regressions were utilized to assess mortality. Results: Baseline osteosarcopenia affected 75 patients (17.2%). Psoas density decreased by 1.569 HU/year (95% confidence interval (CI) −1.703 to −1.434 HU/yr). Nonlinear models estimated mean declines in psoas volume (−6.42 cm3/year) and bone density (−6.01 HU/year). Among deceased patients, modelled final-year declines showed −12.57% in psoas density and −10.28% in psoas volume. Baseline osteosarcopenia was associated with higher all-cause mortality (Hazard Ratio (HR) 1.611; 95% CI 1.134–2.288; p = 0.008). Conclusions: Osteosarcopenia is common and progressive in metastatic prostate cancer, and muscle loss accelerates near death. Baseline osteosarcopenia independently identifies patients at increased mortality risk. CT imaging provides a scalable approach for longitudinal assessment of musculoskeletal health and offers clinically important information without additional patient burden.
SN  - 2077-0383
ER  -