PSA Nadir and Time to PSA Nadir Following Androgen Deprivation Therapy are the Predictors for Castration-Resistant Prostate Cancer in Patients| Stephy publishers

 


Abstract

Purpose: To evaluate the influence of nadir prostate-specific antigen (PSA) level and time to PSA nadir following androgen deprivation therapy (ADT)on disease progression of castration-resistant prostate cancer (CRPC) in patients with metastatic, hormone-sensitive prostate cancer (mHSPC).

Patients and methods: A total of 90 patients with metastatic, hormone-sensitive prostate cancer treated with androgen deprivation therapy in our hospital were included in our retrospective study. Patients’ characteristics, PSA at PADT initiation (initial PSA), PSA nadir, TTN, follow up time, CRPC event were analyzed using Kaplan-Meier analysis and Cox regression model.

Results: At a median follow-up of 12 months, 57 patients (63.3%) showed disease progression of CRPC Both PSA nadir and time to PSA nadir (TTN) was independent and significant predictors of CRPC event. Patients with higher PSA nadir (≥0.2ng/dL) and shorter time to PSA nadir (TTN <6 months) had significant shorter time to CRPC. Meanwhile, the Gleason score, age and initial PSA werenot significant predictors of disease progression. In the combined analyses showed patients with higher of PSA nadir and shorter TTN had significantly higher risk for CRPC event compared to lower PSA nadir and longer TTN (HR 69.243, p-value< 0.001)

Conclusion: We concluded that both higher PSA nadir and shorter time to PSA nadir are significant predictors of CRPC in patients with metastatic, hormone-sensitive prostate cancer receiving ADT.


Keywords
Metastatichormone sensitive prostate cancer, Androgen deprivation therapy, Time to PSA nadir, PSA nadir, Castration resistant prostate cancer


Introduction

Androgen-deprivation therapy (ADT) is the most effective systemic therapy in patients who have hormone-sensitive prostate cancer. PSA levels remain low or undetectable for years.1 However, the emergence of castration-resistant prostate cancer (CRPC) is typical.2 Treatment options for CRPC remain limited and the prognosis of patient with CRPC is dismal.3 With hormone treatment of advanced prostate cancer, PSA level increases 6 to 12 months before definitive radiological or clinical of disease progression.4-7 Median survival in patients with CRPC is approximately 24 to- 36months.1 The accurate prediction parameter of disease progression might be used to evaluate prognosis of disease and benefit from aggressive or novel treatment. PSA kinetics have been used as useful prognostic indicators for disease or survival in different clinical setting including radical prostatectomy and external beam radiation therapy.8-11 Nevertheless, its prognostic ability for those receiving ADT for metastatic, hormone-sensitive prostate cancer is not well understood. The PSA nadir has been suggested to be the most significant predictor of progression to CRPC in many studies. 12-17 However, the time to PSA nadir (TTN) is still controversy. Some earlier studies suggested that shorter TTN correlated with longer time of progression-free survival.4,5,18-20 But many recent studies suggested that longer TTN correlated with longer time of progression-free survival.1,16,17,21,22 In our study, we retrospectively reviewed our single-center treatment of metastatic-hormone sensitive prostate cancer (mHSPC) patients to evaluate the prognostic ability of PSA nadir and TTN in both individual and interactive effect on disease progression to CRPC.


Materials and Methods

As a retrospective cohort study. The database in Thammasat university hospital between July 2012 and December 2019. A total of 90 patients who diagnosed metastatic-hormone sensitive prostate cancer and received androgen-deprivation therapy (ADT) such as gonadotropin-releasing hormone (GnRH) agonist plus anti-androgen, GnRH antagonist or bilateral orchiectomy were included in this study. GnRHagonist combined with anti-androgen were used in 23 patients (25.5%), GnRH antagonist was used in 20 patients (22.2%) and bilateral orchiectomy was used in 47 patients (52.2%). Patients were followed up a progression of disease by PSA every 3 months thereafter. We determined the study size by using a hazard ratio = 4.3,21 CRPC event = 30%, Patients who loss to follow-up=10%, power 80%, p=0.05 and two-sided test. We found that the study size was 42 patients. Predictors used in multivariate analysis (Cox’s proportional hazard model) were Gleason score, initial PSA, PSA nadir, TTN (add 10 patients per predictor). Thus, the study size was appropriately at least 82 patients.


To read more #Nephrology
https://www.stephypublishers.com/tunr/fulltext/TUNR.MS.ID.000504.php


#Openaccessjournals
https://www.stephypublishers.com/

Comments

Post a Comment

Popular posts from this blog

Journal of Psychological Science and Research - (JPSSR) | Stephy Publishers

Image
  Journal of Psychological Science and Research - (JPSSR) | Stephy Publishers Journal of Psychological Science and Research is an international, peer reviewed open access journal, aims to publish articles on entire spectrum of the science of psychology. JPsSR acts as a source for the latest findings in social, developmental, cognitive, community, and health psychology, as well as behavioral neuroscience and biopsychology. The journal aims to publish high quality articles in the form of original research, review, case reports, mini-review, commentary, proceeding, editorial, etc. #Manuscriptsubmission https://www.stephypublishers.com/submit-manuscript.php More #Openaccessjournals https://www.stephypublishers.com/ # PsychologicalScience https://www.stephypublishers.com/psychological-science-and-research/
Read more
Image
 Resilience, Risk-Taking Behavior and Aggression among Female Volleyball Players – a Preliminary Study The aim of the current study is to investigate the level of risk-taking behavior, resilience and aggression in female volleyball players and the link between these psychological variables and coach’s performance ranking. A Romanian volleyball team ranked 7th out of 11 in the A1 league in the national championship (2022-2023 period) participated at the study. The Romanian adaptation of the Brief Resilience Scale, The Romanian adaptation of Makarowski’s Stimulating and Instrumental Risk Questionnaire, The Romanian adaptation of Makarowski's Aggression Questionnaire and Delphi method (evaluation of female volleyball players by coaches) were used. Analysis of the results reveals that athletes have a low level of perseverance (Go-Ahead factor), a low level of Foul play and a moderate to low level of assertiveness. Also, most athletes registered average or even low levels of resilience
Read more
Image
 Chemo stratigraphic Profile of a Reservoir in Well “X” of Field “Y” Offshore Southern Gabon - Stephy Publishers In a bid to evaluate the elemental and mineralogical content of reservoir samples from the “X” well in the “Y” oil field offshore Southern Gabon, analyses were performed using XRD and XRF. The log view profile of the result inferred that Na, Mg, and Calcite were absent in the shallower series of the reservoir sandstones studied, this observation implies that they are soluble ions that had eroded and refer to warm and humid paleoclimate and a depositional environment that is arid, which corresponds to the continental crust as their source. The plot of Ti and FeO+Mg discriminate the deeper series of the reservoir sandstone samples from the shallower samples. The lower series showed heavier values which implies their origin from Oceanic Crust. These are also the pre-salt facies while the shallower series were more of continental origin and represent the post-salt facies. https:
Read more