Korean J Urol.  2007 Apr;48(4):408-415. 10.4111/kju.2007.48.4.408.

Predictive Variables of the Progression to Androgen Independent Prostate Cancer after Combined Androgen Blockade

• Park SC
• Choi HY
• Kim CS
• Hong SJ
• Kim WJ
• Lee SE
• Song JM
• Yoon JH
• Rim JS

• KMID: 1997108
• DOI: http://doi.org/10.4111/kju.2007.48.4.408

Abstract

PURPOSE
Despite of the effectiveness of androgen deprivation therapy for prostate cancer, it progress to androgen independent prostate cancer (AIPC) after various periods of time. The objective of this study was to analyze the clinical and pathological variables that predict progression to AIPC after combined androgen blockade (CAB).
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 343 patients who were treated with CAB for prostate cancer. Binary logistic regression test was used to analyze the independent predictors for the progression to AIPC. The time to AIPC, according to variables, was assessed by the Kaplan-Meier method and the variables were compared using the Log-Rank test.
RESULTS
The mean follow-up was 42.1 months (range: 12-120). Seventy seven patients (33.3%) experienced progression to AIPC at a median of 20.2 months (range: 6-72). On univariate analysis, the percentage of positive prostate biopsies, the Gleason score, the T stage, the extent of bone metastasis, lymph node metastasis, the pretreatment PSA level, the nadir PSA and the PSA level at 3 and 6 months all had a significant relationship with the progression to AIPC. The receiver operating characteristic curve analysis for the nadir PSA showed that the optimal cut-off point to predict progression to AIPC was 0.5ng/ml with an area under curve of 0.769. A multivariate analysis demonstrated that the Gleason score (>7), the nadir PSA (>0.5ng/ml), and the PSA level at 6 months (>4.0ng/ml) were significantly correlated with the progression to AIPC.
CONCLUSIONS
This study suggested that Gleason score, the nadir PSA and the PSA level at 6 months were independent variables to predict progression to AIPC after CAB. The PSA level at 6 months may be the most accurate variable to predict progression to AIPC.

Keyword

Prostate cancer; Hormone; Progression

MeSH Terms

Area Under Curve
Biopsy
Follow-Up Studies
Humans
Logistic Models
Lymph Nodes
Medical Records
Multivariate Analysis
Neoplasm Grading
Neoplasm Metastasis
Prostate*
Prostatic Neoplasms*
Retrospective Studies
ROC Curve

Figure

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  Fig. 1. Study Schema. CAB: combined androgen blockade, AIPC: androgen independent prostate cancer.

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  Fig. 2. Receiver operating characteristics curve analysis of the nadir prostate-specific antigen (PSA) to predict progression to androgen independent prostate cancer. AUC: area under curve.

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  Fig. 3. Time to progression to androgen independent prostate cancer according to the T stage, the extent of bone metastasis, the pretreatment prostate-specific antigen (PSA), the nadir PSA, the PSA level at 3 months and the PSA level at 6 months.

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