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Abstract
Objective. The influence of prostate-specific antigen (PSA) kinetics on the outcome of metastatic prostate cancer (PCa) after androgen-deprivation therapy (ADT) remains poorly characterised. We evaluated the prognostic significance of PSA nadir and time to PSA nadir as well as their interactive effect on prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) after ADT.
Methods. A total of 650 men with advanced or metastatic PCa treated with ADT were studied. The prognostic significance of PSA nadir and time to PSA nadir on PCSM and ACM were analysed using Kaplan–Meier analysis and the Cox regression model.
Results. On multivariate analysis, clinical M1 stage, Gleason Score 8–10, PSA nadir ≥ 0.2 ng/ml and time to PSA nadir < 10 months were independent predictors of PCSM and ACM. The combined analysis showed that patient with higher PSA nadir and shorter time to PSA nadir had significantly higher risk of PCSM and ACM compared to those with lower PSA nadir and longer time to PSA nadir (hazard ratios = 6.30 and 4.79, respectively, all P < 0.001).
Conclusions. Our results suggest that higher PSA nadir level and faster time to reach PSA nadir after ADT were associated with shorter survival for PCa.
Acknowledgements
This study was supported by grants from the Taiwan National Science Council (NSC 95-2314-B-037-053-MY2, NSC 96-2314-B-037-012-MY3 and NSC 99-2314-B-037-018-MY3), Kaohsiung Medical University Hospital (KMUH96-6G27 and KMUH96-6G28) and Kaohsiung Municipal Hsiao-Kang Hospital (kmhk-96-009 and kmhk-97-008). The authors thank Ms. Chao-Shih Chen and Professor Hung-Yi Chuang for their help on data analyses.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.