Korean J Urol.  2012 Sep;53(9):607-613. 10.4111/kju.2012.53.9.607.

Prostate-Specific Antigen Nadir and Time to Prostate-Specific Antigen Nadir Following Maximal Androgen Blockade Independently Predict Prognosis in Patients with Metastatic Prostate Cancer

• Hong SY
• Cho DS
• Kim SI
• Ahn HS
• Kim SJ

• KMID: 2061698
• DOI: http://doi.org/10.4111/kju.2012.53.9.607

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 (> or =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.

Keyword

Prognosis; Prostate-specific antigen; Prostatic neoplasms

MeSH Terms

Disease Progression
Disease-Free Survival
Follow-Up Studies
Humans
Kinetics
Multivariate Analysis
Prognosis
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Prostate-Specific Antigen

Figure

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  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).

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  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).

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  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.

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