Early Evaluation of PSA Response in Metastatic Prostate Cancer Treated with Abiraterone  

作　　者：Ana Santafé-Jiménez Virginia Morillo-Macías Angel Sánchez-Iglesias Encarnación Fernández-Camacho Carlos Ferrer-Albiach Ana Santafé-Jiménez;Virginia Morillo-Macías;Angel Sánchez-Iglesias;Encarnación Fernández-Camacho;Carlos Ferrer-Albiach(Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain)

机构地区：[1]Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain

出　　处：《Open Journal of Urology》2021年第7期251-263,共13页泌尿学期刊（英文）

摘　　要：<strong>Background:</strong> According to the main prostate cancer guidelines, the response to treatment with abiraterone plus prednisone (AA+P) must be evaluated by assessing prostate-specific antigen (PSA) levels at 12 weeks. Recent studies have shown that early PSA decline, at 4 weeks, maybe a surrogate marker for survival. The objective of this work was to analyze if a decline in PSA at 4 weeks correlates with a better outcome in terms of OS (overall survival) and PFS (progression-free survival). <strong>Methods:</strong> We evaluated 168 patients (with a median age of 71 years) with prostate cancer who had started AA+P treatment between February 2012 and July 2019. Patients were divided into three different groups according to the decline of PSA (≥30%, ≥50%, and ≥90%) at 4, 8, and 12 weeks. Statistical survival analysis was performed using the Kaplan-Meier method. <strong>Results:</strong> After a follow-up of 69 months, a PSA decline ≥ 30% at 4 weeks was associated with longer median OS times (28 vs. 18 months;<em>p</em> = 0.027). A decline in PSA by ≥50% was also associated with increased median OS times (36 vs. 21;<em>p</em> = 0.003). Cox univariable analysis indicated that a decrease in PSA (both by ≥30% and ≥50) were predictive of OS at 4 weeks (PSA ≥ 30%: HR = 1.568, 95%CI [1.041, 2.360], <em>p</em> = 0.031;PSA ≥ 50%: HR = 1.901, 95% CI [1.222, 2.956], <em>p</em> = 0.004);although multivariable analysis did not confirm these results. The prior administration of chemotherapy was an independent risk factor for death (HR = 2.511;p < 0.001) and progression (HR = 3.238;p < 0.001), probably because of different factors. <strong>Conclusion:</strong> A decrease in PSA by ≥30% or ≥50% at 4 weeks after starting treatment with AA+P correlated with longer PFS and OS, and provides clinically meaningful information guiding the physicians towards a personalized treatment.<strong>Background:</strong> According to the main prostate cancer guidelines, the response to treatment with abiraterone plus prednisone (AA+P) must be evaluated by assessing prostate-specific antigen (PSA) levels at 12 weeks. Recent studies have shown that early PSA decline, at 4 weeks, maybe a surrogate marker for survival. The objective of this work was to analyze if a decline in PSA at 4 weeks correlates with a better outcome in terms of OS (overall survival) and PFS (progression-free survival). <strong>Methods:</strong> We evaluated 168 patients (with a median age of 71 years) with prostate cancer who had started AA+P treatment between February 2012 and July 2019. Patients were divided into three different groups according to the decline of PSA (≥30%, ≥50%, and ≥90%) at 4, 8, and 12 weeks. Statistical survival analysis was performed using the Kaplan-Meier method. <strong>Results:</strong> After a follow-up of 69 months, a PSA decline ≥ 30% at 4 weeks was associated with longer median OS times (28 vs. 18 months;<em>p</em> = 0.027). A decline in PSA by ≥50% was also associated with increased median OS times (36 vs. 21;<em>p</em> = 0.003). Cox univariable analysis indicated that a decrease in PSA (both by ≥30% and ≥50) were predictive of OS at 4 weeks (PSA ≥ 30%: HR = 1.568, 95%CI [1.041, 2.360], <em>p</em> = 0.031;PSA ≥ 50%: HR = 1.901, 95% CI [1.222, 2.956], <em>p</em> = 0.004);although multivariable analysis did not confirm these results. The prior administration of chemotherapy was an independent risk factor for death (HR = 2.511;p < 0.001) and progression (HR = 3.238;p < 0.001), probably because of different factors. <strong>Conclusion:</strong> A decrease in PSA by ≥30% or ≥50% at 4 weeks after starting treatment with AA+P correlated with longer PFS and OS, and provides clinically meaningful information guiding the physicians towards a personalized treatment.

关 键 词：Prostate Cancer ABIRATERONE Prostate-Specific Antigen Decline SURVIVAL 

分 类 号：R73[医药卫生—肿瘤]