Impact of nadir PSA level and time to nadir during initial androgen deprivation therapy on prognosis in patients with metastatic castration-resistant prostate cancer
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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.
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.
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].
Higher PSA nadir and shorter TTN during the initial ADT are poor prognostic factors in patients with mCRPC.
KeywordsPSA nadir Time to nadir Metastatic castration-resistant prostate cancer Prognosis
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.
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
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.
- 6.Nakajima K, Kaneko G, Takahashi S et al (2018) Role of bone scan index in the prognosis and effects of therapy on prostate cancer with bone metastasis: study design and rationale for the multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index (PROSTAT-BSI) study. Int J Urol 25:492CrossRefGoogle Scholar
- 13.Teoh JY, Tsu JH, Yuen SK et al (2015) Prognostic significance of time to prostate-specific antigen (PSA) nadir and its relationship to survival beyond time to PSA nadir for prostate cancer patients with bone metastases after primary androgen deprivation therapy. Ann Surg Oncol 22:1385CrossRefGoogle Scholar
- 20.Matsumoto T, Hatakeyama S, Ookubo T et al (2017) Cost-effectiveness comparison between neoadjuvant chemohormonal therapy and extended pelvic lymph node dissection in high-risk prostate cancer patients treated with radical prostatectomy: a multi-institutional analysis. Med Oncol 34:190CrossRefGoogle Scholar
- 28.Kitagawa Y, Ueno S, Izumi K et al (2014) Nadir prostate-specific antigen (PSA) level and time to PSA nadir following primary androgen deprivation therapy as independent prognostic factors in a Japanese large-scale prospective cohort study (J-CaP). J Cancer Res Clin Oncol 140:673CrossRefGoogle Scholar