The purpose of this study was to evaluate the relationship between the kinetics of prostate specific antigen (PSA) decline after androgen deprivation therapy (ADT) initiation and overall survival (OS) in men with metastatic hormone-sensitive prostate cancer (HSPC)
Our institutional medical records were used to identify a cohort of men with metastatic HSPC who were treated with ADT. Patients were included if they had at least 2 serum PSA determinations before PSA nadir and at least 1 serum PSA value available within 1 month of ADT initiation. Patient characteristics, PSA at ADT initiation, PSA after 3month of ADT, nadir PSA, and time to PSA nadir (TTN) in relation to OS were analyzed.
Seventy-nine patients were identified, and they had a median follow-up after ADT initiation of 49 months. The median OS after ADT initiation was 21 months. The median PSA level at ADT initiation and PSA nadir were 150 ng/mL and 5.34 ng/mL, respectively. On univariate analysis: TTN <6 months, PSA after 3m ADT > 0.2 ng/mL, PSA Nadir > 0.2 ng/mL, and Gleason score >7 were associated with shorter OS. On multivariate analysis, TTN <6 months, Gleason score >7, Post 3month ADT PSA and PSA nadir >or=0.2 ng/mL independently predicted shorter OS. Most of patients with bad prognostic factors were died within 24 months of ADT.
This was the report to demonstrate that a PSA level after 3 months of ADT was associated with shorter survival duration in men with metastatic HSPC likewise PSA nadir. These results need confirmation but may indicate that early PSA response (less than 3 month) can identify the patient’ s bad prognosis without waiting the results of PSA nadir and TTN. Therefore PSA level after 3 months of ADT may help to determinate which were good to patient between the early aggressive treatment and delayed treatment.