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Predictors of survival in prostate cancer patients with bone metastasis and extremely high prostate-specific antigen levels.

Koo KC, Park SU, Kim KH, Rha KH, Hong SJ, Yang SC, Chung BH - Prostate Int (2015)

Bottom Line: During the follow-up period (median, 39.9 months; interquartile range, 21.5-65.9 months), there were no differences between the groups in terms of the survival endpoints.PSA response to androgen deprivation therapy and serum ALP are reliable predictors of survival in patients with BMPCa presenting with extremely high PSA levels.These patients should not be deterred from active treatment based on baseline PSA values.

View Article: PubMed Central - PubMed

Affiliation: Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.

ABSTRACT

Purpose: Prostate-specific antigen (PSA) is a surrogate marker of disease progression; however, its predictive ability in the extreme ranges is unknown. We determined the predictors of survival in patients with bone metastatic prostate cancer (BMPCa) and with extremely high PSA levels.

Methods: Treatment-naïve patients (n = 248) diagnosed with BMPCa between December 2002 and June 2012 were retrospectively analyzed. Clinicopathological features at diagnosis, namely age, body mass index, serum alkaline phosphatase (ALP) and PSA levels, PSA nadir, time to PSA nadir and its maintenance period, PSA declining velocity, Gleason grade, clinical T stage, pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), and the number of bone metastases were assessed. The patients were stratified according to PSA ranges of <20 ng/mL, 20-100 ng/mL, 100-1000 ng/mL, and 1000-10,000 ng/mL. Study endpoints were castration-resistant PCa (CRPC)-free survival and cancer-specific survival (CSS).

Results: Patients with higher PSA and ALP levels showed more bone lesions (P < 0.001). During the follow-up period (median, 39.9 months; interquartile range, 21.5-65.9 months), there were no differences between the groups in terms of the survival endpoints. High ALP levels, shorter time to PSA nadir, and pain were associated with an increased risk of progression to CRPC, and high ALP levels, ECOG PS ≥ 1, and higher PSA nadir independently predicted CSS.

Conclusions: PSA response to androgen deprivation therapy and serum ALP are reliable predictors of survival in patients with BMPCa presenting with extremely high PSA levels. These patients should not be deterred from active treatment based on baseline PSA values.

No MeSH data available.


Related in: MedlinePlus

Comparative survival curves of patients with bone metastatic prostate cancer for progression to castration-resistant prostate cancer (CRPC)-free survival. (A) Survival curve stratified according to serum prostate-specific antigen (PSA) levels. (B) Survival curve stratified according to serum alkaline phosphatase (ALP) levels dichotomized at 200 IU/L. (C) Survival curve stratified according to PSA nadir levels dichotomized at 0.2 ng/mL. (D) Survival curve stratified according to time to PSA nadir (TTN) dichotomized at 9 months.
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fig1: Comparative survival curves of patients with bone metastatic prostate cancer for progression to castration-resistant prostate cancer (CRPC)-free survival. (A) Survival curve stratified according to serum prostate-specific antigen (PSA) levels. (B) Survival curve stratified according to serum alkaline phosphatase (ALP) levels dichotomized at 200 IU/L. (C) Survival curve stratified according to PSA nadir levels dichotomized at 0.2 ng/mL. (D) Survival curve stratified according to time to PSA nadir (TTN) dichotomized at 9 months.

Mentions: Survival data as of March 2014 were used in this analysis. During the median follow-up period of 39.9 months (interquartile range, 21.5–65.9 months), there were no differences in the CRPC-free survival and CSS between the different PSA groups (Figs. 1A and 2A). Comparative survival outcomes of covariates considered potential predictors by the Cox-proportional hazards analysis were analyzed according to each cutoff value. Patients with high ALP levels (≥200 IU/L) were found to have significantly worse CRPC-free survival (P = 0.001) and CSS (P = 0.005) compared to patients with ALP levels < 200 IU/L (Figs. 1B and 2B). Moreover, patients who achieved a PSA nadir value of ≥0.2 ng/mL following ADT, revealed worse CSS compared to those with PSA nadir <0.2 ng/mL (P = 0.001; Fig. 2C). However, PSA nadir was not associated with an increased risk of CRPC progression (P = 0.614; Fig. 1C). Patients with a TTN of <9 months showed significantly worse CRPC-free survival (P = 0.024) and CSS (P = 0.022) compared to those with TTN of ≥9 months (Figs. 1D and 2D).


Predictors of survival in prostate cancer patients with bone metastasis and extremely high prostate-specific antigen levels.

Koo KC, Park SU, Kim KH, Rha KH, Hong SJ, Yang SC, Chung BH - Prostate Int (2015)

Comparative survival curves of patients with bone metastatic prostate cancer for progression to castration-resistant prostate cancer (CRPC)-free survival. (A) Survival curve stratified according to serum prostate-specific antigen (PSA) levels. (B) Survival curve stratified according to serum alkaline phosphatase (ALP) levels dichotomized at 200 IU/L. (C) Survival curve stratified according to PSA nadir levels dichotomized at 0.2 ng/mL. (D) Survival curve stratified according to time to PSA nadir (TTN) dichotomized at 9 months.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494633&req=5

fig1: Comparative survival curves of patients with bone metastatic prostate cancer for progression to castration-resistant prostate cancer (CRPC)-free survival. (A) Survival curve stratified according to serum prostate-specific antigen (PSA) levels. (B) Survival curve stratified according to serum alkaline phosphatase (ALP) levels dichotomized at 200 IU/L. (C) Survival curve stratified according to PSA nadir levels dichotomized at 0.2 ng/mL. (D) Survival curve stratified according to time to PSA nadir (TTN) dichotomized at 9 months.
Mentions: Survival data as of March 2014 were used in this analysis. During the median follow-up period of 39.9 months (interquartile range, 21.5–65.9 months), there were no differences in the CRPC-free survival and CSS between the different PSA groups (Figs. 1A and 2A). Comparative survival outcomes of covariates considered potential predictors by the Cox-proportional hazards analysis were analyzed according to each cutoff value. Patients with high ALP levels (≥200 IU/L) were found to have significantly worse CRPC-free survival (P = 0.001) and CSS (P = 0.005) compared to patients with ALP levels < 200 IU/L (Figs. 1B and 2B). Moreover, patients who achieved a PSA nadir value of ≥0.2 ng/mL following ADT, revealed worse CSS compared to those with PSA nadir <0.2 ng/mL (P = 0.001; Fig. 2C). However, PSA nadir was not associated with an increased risk of CRPC progression (P = 0.614; Fig. 1C). Patients with a TTN of <9 months showed significantly worse CRPC-free survival (P = 0.024) and CSS (P = 0.022) compared to those with TTN of ≥9 months (Figs. 1D and 2D).

Bottom Line: During the follow-up period (median, 39.9 months; interquartile range, 21.5-65.9 months), there were no differences between the groups in terms of the survival endpoints.PSA response to androgen deprivation therapy and serum ALP are reliable predictors of survival in patients with BMPCa presenting with extremely high PSA levels.These patients should not be deterred from active treatment based on baseline PSA values.

View Article: PubMed Central - PubMed

Affiliation: Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.

ABSTRACT

Purpose: Prostate-specific antigen (PSA) is a surrogate marker of disease progression; however, its predictive ability in the extreme ranges is unknown. We determined the predictors of survival in patients with bone metastatic prostate cancer (BMPCa) and with extremely high PSA levels.

Methods: Treatment-naïve patients (n = 248) diagnosed with BMPCa between December 2002 and June 2012 were retrospectively analyzed. Clinicopathological features at diagnosis, namely age, body mass index, serum alkaline phosphatase (ALP) and PSA levels, PSA nadir, time to PSA nadir and its maintenance period, PSA declining velocity, Gleason grade, clinical T stage, pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), and the number of bone metastases were assessed. The patients were stratified according to PSA ranges of <20 ng/mL, 20-100 ng/mL, 100-1000 ng/mL, and 1000-10,000 ng/mL. Study endpoints were castration-resistant PCa (CRPC)-free survival and cancer-specific survival (CSS).

Results: Patients with higher PSA and ALP levels showed more bone lesions (P < 0.001). During the follow-up period (median, 39.9 months; interquartile range, 21.5-65.9 months), there were no differences between the groups in terms of the survival endpoints. High ALP levels, shorter time to PSA nadir, and pain were associated with an increased risk of progression to CRPC, and high ALP levels, ECOG PS ≥ 1, and higher PSA nadir independently predicted CSS.

Conclusions: PSA response to androgen deprivation therapy and serum ALP are reliable predictors of survival in patients with BMPCa presenting with extremely high PSA levels. These patients should not be deterred from active treatment based on baseline PSA values.

No MeSH data available.


Related in: MedlinePlus