Cancer is a result of regulated cellular growth which eventually disrupts normal bodily function. With individuals assigned male at birth (AMAB), prostate cancer (PCa) is the second most common cancer both globally and in the United States. In an advance state, cancerous cells can metastasize—leave the primary cancer site—and survive in a new organ. In the case of PCa, the skeleton is a common site for metastasis. The toll that cancer, especially advanced metastatic cancer, takes on a person can lead to social and financial instability as those diagnosed with cancer are at a higher risk of depression, suicide, and loss of employment. Job loss may also lead to the loss of healthcare insurance which can limit or completely erase a person’s access to their treatment options. These factors can impact a person’s ability to maintain their livelihood, placing them in more vulnerable situations that are associated with higher rates of mortality due to unexpected and/or suspicious circumstances of forensic relevance.
Forensic anthropology often employs medical imaging (e.g., radiographic imaging and computed tomography (CT)) to visualize unique internal features of skeletal remains to aid in identification. While certain skeletal elements like cranial sinuses are proven to be accurate and reliable in forensic identifications, research is increasing surrounding the use of pathological conditions for identifications.
This research focuses on analyzing computed X-ray tomography of metastatic skeletal lesions in 14 PCa patients from Boston Medical Center (BMC) over a 10-year period to observe and record how the size, appearance, and anatomical location of skeletal metastatic lesions may change overtime. This preliminary research looks to better understand the evolution of cancerous metastatic bone disease in PCa patients and contemplate if these lesions may one day be a viable identification method in forensic anthropology, highlighting a unique forensic anthropological focus of this research compared to previous studies on PCa.
The BMC PCa sample had lesion behavior comparable to previous clinical studies of PCa patients with metastatic bone disease. With the BMC PCa sample, metastatic lesions developed most in the spine, pelves, and rib cage, with the thoracic and lumbar vertebrae having the highest metastatic burden. The visual appearance and anatomical location of a lesion was usually stable across time unless is resolved or became too small for visual analysis at some point during the study. While no results were statistically significant, similar developments were seen across the sample. Once lesions developed in the lumbar vertebrae, it was most likely that those lesions would be present throughout the entire observation period, versus lesions that developed elsewhere in the skeleton. Metastatic lesions tended to increase in size than decrease or remain static, developing the largest in the pelvic region. Bone density and vascularity and/or type of therapeutic treatment received may factor in as influential aspects in lesion development.
This study provides detailed research on the behavior and characteristics of metastatic skeletal lesions in PCa patient with the aim of investigating their potential use as a secondary means of identification in forensic anthropology. The results showed that the location appearance of the lesions was often stable, but their size could fluctuate over time. Though direct comparison between antemortem and postmortem radiographs of skeletal metastatic lesions may not be fully accurate at this time, the study suggests that further research in this area, and overall inclusion of pathological conditions in a forensic setting, would be valuable for forensic investigations and beneficial to other disciplines.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47981 |
| Date | 30 January 2024 |
| Creators | Tyler, Janelle Ann |
| Contributors | Tallman, Sean, Mercier, Gustavo |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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