{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:52:07Z","timestamp":1791564727742,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metastatic prostate cancer (mPCa) exhibits highly complex metastatic patterns. Comprehensive evaluation of distinct metastatic patterns and their integrated prognostic impact remains lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with mPCa were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and metastatic patterns were systematically characterized. Cancer\u2010specific survival (CSS) and overall survival (OS) were estimated using the Kaplan\u2013Meier method and compared using multivariable Cox regression. Based on metastatic characteristics, patients were classified into seven pattern\u2010based categories and subsequently consolidated into four risk groups (low, intermediate, high, and very high). Temporal robustness was assessed across diagnostic periods, and prognostic discrimination was compared with the conventional M classification using Harrell's C\u2010index and time\u2010dependent area under the receiver operating characteristic curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 13,325 patients with mPCa were identified. Compared with M1b disease, liver\u2010only and multiple visceral metastases were associated with significantly poorer survival (all HR\u2009&gt;\u20091,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), whereas lung\u2010only and other single visceral metastases showed comparable outcomes (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Concomitant distant lymph node involvement adversely affected survival primarily in M1b disease (all HR\u2009&gt;\u20091,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), while concomitant bone involvement worsened outcomes in most subgroups except those with multiple visceral sites. Integrating these findings, the four\u2010tier risk stratification model demonstrated clear stepwise discrimination for both CSS (Low risk as reference; Intermediate: HR\u2009=\u20091.63, 95% CI, 1.45\u20131.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; High: HR\u2009=\u20092.04, 95% CI, 1.76\u20132.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Very high: HR\u2009=\u20093.99, 95% CI, 3.39\u20134.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and OS (Low risk as reference; Intermediate: HR\u2009=\u20091.53, 95% CI, 1.38\u20131.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; High: HR\u2009=\u20091.93, 95% CI, 1.70\u20132.19,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Very high: HR\u2009=\u20093.48, 95% CI, 2.99\u20134.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Temporal robustness analysis showed consistent stepwise survival gradients across both diagnostic periods. Compared with the conventional M classification, the four\u2010tier risk model showed higher C\u2010index values for CSS (0.695 vs 0.638) and OS (0.696 vs 0.639), with consistently higher time\u2010dependent AUCs at 12, 36, and 60 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Survival varies substantially across metastatic patterns in mPCa. A simplified four\u2010tier risk stratification model integrating multidimensional metastatic features may provide incremental prognostic information beyond conventional M staging, although further external validation is required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70204","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T18:17:06Z","timestamp":1781029026000},"page":"1263-1272","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive Characterization of Metastatic Patterns and a Redefined Prognostic Framework in Metastatic Prostate Cancer"],"prefix":"10.1002","volume":"86","author":[{"given":"Shiqiang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Urology, The Seventh Affiliated Hospital Sun Yat\u2010sen University Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyu","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Urology, The Seventh Affiliated Hospital Sun Yat\u2010sen University Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiran","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Urology, The Seventh Affiliated Hospital Sun Yat\u2010sen University Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikun","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Urology, The Seventh Affiliated Hospital Sun Yat\u2010sen University Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyun","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Urology, The Seventh Affiliated Hospital Sun Yat\u2010sen University Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21820"},{"key":"e_1_2_13_4_1","unstructured":"Centers for Disease Control and Prevention. U.S. Cancer Statistics: Prostate Cancer Stat Bite. U.S. Department of Health and Human Services;2025.https:\/\/www.cdc.gov\/united-states-cancer-statistics\/publications\/prostate-cancer-stat-bite.html."},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.0228"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40618-3"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2023.08.004"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0309941"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2019.03.020"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euros.2024.06.006"},{"key":"e_1_2_13_11_1","unstructured":"National Cancer Institute. Number of Persons by Race and Hispanic Ethnicity for SEER Participants. accessed on 1 December 2025.https:\/\/seer.cancer.gov\/registries\/data.html."},{"key":"e_1_2_13_12_1","unstructured":"Surveillance Epidemiology and End Results (SEER) ProgramSEER*Stat Database: Incidence \u2010 SEER Research Data 17 Registries Nov 2023 Sub (2000\u20102021) \u2010 Linked To County Attributes \u2010 Time Dependent (1990\u20102022) Income\/Rurality 1969\u20102022 Counties National Cancer Institute DCCPS Surveillance Research Program 2025 www.seer.cancer.gov."},{"key":"e_1_2_13_13_1","unstructured":"U.S. Preventive Services Task Force. Prostate cancer: Screening. 2012 accessed 1 December 2025 https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/recommendation\/prostate-cancer-screening-2012."},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.14905"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2021.5143"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.22742"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.21037\/tcr.2019.05.31"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.5489\/cuaj.7173"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.7150\/jca.29481"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.07.020"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.23492"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-021-03721-6"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2023.13749"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/mdb2.70004"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/mdb2.70009"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/wsbm.70000"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/wsbm.1646"}],"container-title":["The Prostate"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70204","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pros.70204","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70204","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:02:24Z","timestamp":1791561744000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pros.70204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":26,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/pros.70204"],"URL":"https:\/\/doi.org\/10.1002\/pros.70204","archive":["Portico"],"relation":{},"ISSN":["0270-4137","1097-0045"],"issn-type":[{"value":"0270-4137","type":"print"},{"value":"1097-0045","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]},"assertion":[{"value":"2026-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}