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. 2012 Sep;53(9):607-13.
doi: 10.4111/kju.2012.53.9.607. Epub 2012 Sep 19.

Prostate-specific antigen nadir and time to prostate-specific antigen nadir following maximal androgen blockade independently predict prognosis in patients with metastatic prostate cancer

Seok Young Hong  1 , Dae Sung Cho, Sun Il Kim, Hyun Soo Ahn, Se Joong Kim
Affiliations

Prostate-specific antigen nadir and time to prostate-specific antigen nadir following maximal androgen blockade independently predict prognosis in patients with metastatic prostate cancer

Seok Young Hong et al. Korean J Urol. 2012 Sep.

Abstract

Purpose: To evaluate the influence of prostate-specific antigen (PSA) kinetics following maximal androgen blockade (MAB) on disease progression and cancer-specific survival in patients with metastatic, hormone-sensitive prostate cancer.

Materials and methods: One hundred thirty-one patients with metastatic, hormone-sensitive prostate cancer treated with MAB at our institution were included in this study. Patients' characteristics, PSA at MAB initiation, PSA nadir, time to PSA nadir (TTN), and PSA decline were analyzed by using univariate and multivariate analysis.

Results: At a median follow-up of 30 months, 97 patients (74.0%) showed disease progression and 65 patients (49.6%) died. Fifty-nine patients (45.0%) died from prostate cancer. In the univariate analysis, PSA at MAB initiation, PSA nadir, TTN, and PSA decline were significant predictors of progression-free survival. Also, PSA nadir, TTN, and PSA decline were significant predictors of cancer-specific survival. In the multivariate analysis, higher PSA nadir (≥0.2 ng/ml) and shorter TTN (<8 months) were independent predictors of shorter progression-free and cancer-specific survival. In the combined analysis of PSA nadir and TTN, patients with higher PSA nadir and shorter TTN had the worst progression-free survival (hazard ratio [HR], 14.098; p<0.001) and cancer-specific survival (HR, 14.050; p<0.001) compared with those with lower PSA nadir and longer TTN.

Conclusions: Our results suggest that higher PSA nadir level and shorter TTN following MAB are associated with higher risk of disease progression and poorer survival in patients with metastatic, hormone-sensitive prostate cancer. Furthermore, these two variables have a synergistic effect on the outcome.

Keywords: Prognosis; Prostate-specific antigen; Prostatic neoplasms.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

FIG. 1
FIG. 1
Kaplan-Meier progression-free survival curves according to prostate-specific antigen (PSA) at maximal androgen blockade (MAB) initiation (A), PSA nadir (B), time to PSA nadir (TTN) (C), and PSA decline (D).
FIG. 2
FIG. 2
Kaplan-Meier cancer-specific survival curves according to prostate-specific antigen (PSA) at maximal androgen blockade (MAB) initiation (A), PSA nadir (B), time to PSA nadir (TTN) (C), and PSA decline (D).
FIG. 3
FIG. 3
Kaplan-Meier progression-free (A) and cancer-specific (B) survival curves according to prostate-specific antigen (PSA) nadir and time to PSA nadir (TTN). MAB, maximal androgen blockade.
See this image and copyright information in PMC

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