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Impact of nadir PSA level and time to nadir during initial androgen deprivation therapy on prognosis in patients with metastatic castration-resistant prostate cancer

  • Itsuto Hamano
  • Shingo HatakeyamaEmail author
  • Shintaro Narita
  • Masahiro Takahashi
  • Toshihiko Sakurai
  • Sadafumi Kawamura
  • Senji Hoshi
  • Masanori Ishida
  • Toshiaki Kawaguchi
  • Shigeto Ishidoya
  • Jiro Shimoda
  • Hiromi Sato
  • Koji Mitsuzuka
  • Tatsuo Tochigi
  • Norihiko Tsuchiya
  • Yoichi Arai
  • Tomonori Habuchi
  • Chikara Ohyama
Original Article
  • 19 Downloads

Abstract

Purpose

We determine whether the nadir prostate-specific antigen level (PSA nadir) and time to nadir (TTN) during initial androgen deprivation therapy (ADT) are prognostic factors in metastatic castration-resistant prostate cancer (mCRPC) patients.

Methods

We reviewed the Michinoku Japan Urological Cancer Study Group database, including 321 mCRPC patients. Optimal cutoff values for PSA nadir and TTN on survival were calculated with the receiver operating characteristic (ROC) curve. Patients were stratified into unfavorable (higher PSA nadir and/or shorter TTN) and favorable (lower PSA nadir and longer TTN) groups. The inversed probability of treatment weighing (IPTW)-adjusted Cox proportional hazard model was performed to evaluate the impact of the unfavorable group on overall survival (OS) after CRPC diagnosis.

Results

Median age and follow-up period were 71 years and 35 months, respectively. ROC curve analysis demonstrated cutoffs of PSA nadir > 0.64 ng/mL and TTN < 7 months. The unfavorable group included 248 patients who had significantly shorter OS after mCRPC. The IPTW-adjusted multivariate model revealed that the unfavorable group had a negative impact on OS in mCRPC patients [hazards ratio (HR) 2.98, P < 0.001].

Conclusions

Higher PSA nadir and shorter TTN during the initial ADT are poor prognostic factors in patients with mCRPC.

Keywords

PSA nadir Time to nadir Metastatic castration-resistant prostate cancer Prognosis 

Notes

Acknowledgments

We would like to thank Teppei Okamoto, Takuma Narita, Naoki Fujita, Hiromichi Iwamura, Yuki Fujita, Yukie Nishizawa, and the entire staff of the Department of Urology in Hirosaki University for their invaluable help with the data collection. The authors would also like to thank Enago (www.enago.jp) for the English language review.

Author contributions

IH: manuscript writing, data analysis. SH: manuscript editing, data analysis. SN, MT, TS, SK, SH, MI, TK, SI, JS, HS, KM, and TT: project development, data collection. NT, YA, TH, and CO: project development, critical review and supervision

Funding

This work was supported by a Grant-in-Aid for Scientific Research (Grant Nos. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, 17K16771, 18K16681, 18K16682, 18K16717, 18K16718, 18K16719, and 18K09157) from the Japan Society for the Promotion of Science.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Itsuto Hamano
    • 1
  • Shingo Hatakeyama
    • 1
    Email author
  • Shintaro Narita
    • 2
  • Masahiro Takahashi
    • 3
  • Toshihiko Sakurai
    • 4
  • Sadafumi Kawamura
    • 5
  • Senji Hoshi
    • 6
  • Masanori Ishida
    • 7
  • Toshiaki Kawaguchi
    • 8
  • Shigeto Ishidoya
    • 9
  • Jiro Shimoda
    • 7
  • Hiromi Sato
    • 2
  • Koji Mitsuzuka
    • 3
  • Tatsuo Tochigi
    • 5
  • Norihiko Tsuchiya
    • 4
  • Yoichi Arai
    • 3
  • Tomonori Habuchi
    • 2
  • Chikara Ohyama
    • 1
  1. 1.Department of UrologyHirosaki University School of MedicineHirosakiJapan
  2. 2.Department of UrologyAkita University School of MedicineHondoJapan
  3. 3.Department of UrologyTohoku University School of MedicineSendaiJapan
  4. 4.Department of UrologyYamagata University School of MedicineYamagataJapan
  5. 5.Department of UrologyMiyagi Cancer CenterNatoriJapan
  6. 6.Department of UrologyYamagata Prefectural Central HospitalAoyanagiJapan
  7. 7.Department of UrologyIwate Prefectural Isawa HospitalOshuJapan
  8. 8.Department of UrologyAomori Prefectural Central HospitalAomoriJapan
  9. 9.Department of UrologySendai City HospitalSendaiJapan

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