Treatment strategy for metastatic prostate cancer with extremely high PSA level: reconsidering the value of vintage therapy  

Treatment strategy for metastatic prostate cancer with extremely high PSA level: reconsidering the value of vintage therapy

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作  者:Yasutaka Yamada Shinichi Sakamoto Yoshiyasu Amiya Makoto Sasaki Takayuki Shima Akira Komiya Noriyuki Suzuki Koichiro Akakura Tomohiko Ichikawae Hiroomi Nakatsu 

机构地区:[1]Department of Urology, Asahi General Hospital, Asahi 289-2511, Japan [2]Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan [3]Department of Urology, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan

出  处:《Asian Journal of Andrology》2018年第5期432-437,共6页亚洲男性学杂志(英文版)

摘  要:The prognostic significance of initial prostate-specific antigen (PSA) level for metastatic prostate cancer remains uncertain. We investigated the differences in prognosis and response to hormonal therapies of metastatic prostate cancer patients according to initial PSA levels. We analyzed 184 patients diagnosed with metastatic prostate cancer and divided them into three PSA level groups as follows: low (〈100 ng ml-1), intermediate (100–999 ng ml-1), and high (≥1000 ng ml-1). All patients received androgen deprivation therapy (ADT) immediately. We investigated PSA progression-free survival (PFS) for first-line ADT and overall survival (OS) within each of the three groups. Furthermore, we analyzed response to antiandrogen withdrawal (AW) and alternative antiandrogen (AA) therapies after development of castration-resistant prostate cancer (CRPC). No significant differences in OS were observed among the three groups (P = 0.654). Patients with high PSA levels had significantly short PFS for first-line ADT (P = 0.037). Conversely, patients in the high PSA level group had significantly longer PFS when treated with AW than those in the low PSA level group (P = 0.047). Furthermore, patients with high PSA levels had significantly longer PFS when provided with AA therapy (P = 0.049). PSA responders to AW and AA therapies had significantly longer survival after CRPC development than nonresponders (P = 0.011 and P 〈 0.001, respectively). Thus, extremely high PSA level predicted favorable response to vintage sequential ADT and AW. The current data suggest a novel aspect of extremely high PSA value as a favorable prognostic marker after development of CRPC.The prognostic significance of initial prostate-specific antigen (PSA) level for metastatic prostate cancer remains uncertain. We investigated the differences in prognosis and response to hormonal therapies of metastatic prostate cancer patients according to initial PSA levels. We analyzed 184 patients diagnosed with metastatic prostate cancer and divided them into three PSA level groups as follows: low (〈100 ng ml-1), intermediate (100–999 ng ml-1), and high (≥1000 ng ml-1). All patients received androgen deprivation therapy (ADT) immediately. We investigated PSA progression-free survival (PFS) for first-line ADT and overall survival (OS) within each of the three groups. Furthermore, we analyzed response to antiandrogen withdrawal (AW) and alternative antiandrogen (AA) therapies after development of castration-resistant prostate cancer (CRPC). No significant differences in OS were observed among the three groups (P = 0.654). Patients with high PSA levels had significantly short PFS for first-line ADT (P = 0.037). Conversely, patients in the high PSA level group had significantly longer PFS when treated with AW than those in the low PSA level group (P = 0.047). Furthermore, patients with high PSA levels had significantly longer PFS when provided with AA therapy (P = 0.049). PSA responders to AW and AA therapies had significantly longer survival after CRPC development than nonresponders (P = 0.011 and P 〈 0.001, respectively). Thus, extremely high PSA level predicted favorable response to vintage sequential ADT and AW. The current data suggest a novel aspect of extremely high PSA value as a favorable prognostic marker after development of CRPC.

关 键 词:alternative antiandrogen therapy antiandrogen withdrawal hormonal therapy metastatic prostate cancer PROSTATE-SPECIFICANTIGEN 

分 类 号:TQ116.2[化学工程—无机化工] S682.33[农业科学—观赏园艺]

 

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