World Journal of Urology

, Volume 34, Issue 3, pp 319–327 | Cite as

Clinical outcomes and nadir prostate-specific antigen (PSA) according to initial PSA levels in primary androgen deprivation therapy for metastatic prostate cancer

  • Yasuhide Kitagawa
  • Satoru Ueno
  • Kouji Izumi
  • Yoshifumi Kadono
  • Atsushi Mizokami
  • Shiro Hinotsu
  • Hideyuki Akaza
  • Mikio Namiki
Original Article

Abstract

Purpose

To investigate the clinical outcomes of metastatic prostate cancer patients and the relationship between nadir prostate-specific antigen (PSA) levels and different types of primary androgen deprivation therapy (PADT). This study utilized data from the Japan Study Group of Prostate Cancer registry, which is a large, multicenter, population-based database.

Methods

A total of 2982 patients treated with PADT were enrolled. Kaplan–Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS) in patients treated using combined androgen blockade (CAB) and non-CAB therapies. The relationships between nadir PSA levels and PADT type according to initial serum PSA levels were also investigated.

Results

Among the 2982 enrolled patients, 2101 (70.5 %) were treated with CAB. Although CAB-treated patients had worse clinical characteristics, their probability of PFS and OS was higher compared with those treated with a non-CAB therapy. These results were due to a survival benefit with CAB in patients with an initial PSA level of 500–1000 ng/mL. Nadir PSA levels were significantly lower in CAB patients than in non-CAB patients with comparable initial serum PSA levels.

Conclusions

A small survival benefit for CAB in metastatic prostate cancer was demonstrated in a Japanese large-scale prospective cohort study. The clinical significance of nadir PSA levels following PADT was evident, but the predictive impact of PSA nadir on OS was different between CAB and non-CAB therapy.

Keywords

Prostate cancer Primary androgen deprivation Combined androgen blockade Nadir PSA level Outcome predictor 

References

  1. 1.
    Huggins C, Hodges CV (1972) Studies on prostate cancer: i. the effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. CA Cancer J Clin 22(4):232–240CrossRefPubMedGoogle Scholar
  2. 2.
    Mohler JL, Kantoff PW, Armstrong AJ, Bahnson RR, Cohen M, D’Amico AV, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Kawachi MH, Kuettel M, Lee RJ, Macvicar GR, Malcolm AW, Miller D, Plimack ER, Pow-Sang JM, Richey S, Roach M 3rd, Rohren E, Rosenfeld S, Small EJ, Srinivas S, Stein C, Strope SA, Tward J, Walsh PC, Shead DA, Ho M (2014) National comprehensive cancer network (2013) Prostate cancer, version 1. J Natl Compr Canc Netw 11(12):1471–1479Google Scholar
  3. 3.
    Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N, European Association of Urology (2014) EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 65(2):467–479CrossRefPubMedGoogle Scholar
  4. 4.
    Prostate Cancer Trialists’ Collaborative Group (2000) Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Lancet 355(9241):1491–1498Google Scholar
  5. 5.
    Pagliarulo V, Bracarda S, Eisenberger MA, Mottet N, Schröder FH, Sternberg CN, Studer UE (2012) Contemporary role of androgen deprivation therapy for prostate cancer. Eur Urol 61(1):11–25PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Akaza H, Usami M, Ogawa O, Kagawa S, Kitamura T, Tsukamoto T, Naito S, Hirao Y, Murai M, Yamanaka H (2004) Characteristics of patients with prostate cancer who have initially been treated by hormone therapy in Japan: J-CaP surveillance. Jap J Clin Oncol 34(6):329–336CrossRefGoogle Scholar
  7. 7.
    Hinotsu S, Akaza H, Usami M, Ogawa O, Kagawa S, Kitamura T, Tsukamoto T, Naito S, Namiki M, Hirao Y, Murai M, Yamanaka H, Japan Study Group of Prostate Cancer (J-CaP) (2007) Current status of endocrine therapy for prostate cancer in Japan analysis of primary androgen deprivation therapy on the basis of data collected by J-CaP. Jap J Clin Oncol 37(10):775–781CrossRefGoogle Scholar
  8. 8.
    Cooperberg MR, Hinotsu S, Namiki M, Ito K, Broering J, Carroll PR, Akaza H (2009) Risk assessment among prostate cancer patients receiving primary androgen deprivation therapy. J Clin Oncol 27(26):4306–4313PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Kitagawa Y, Hinotsu S, Shigehara K, Nakashima K, Kawaguchi S, Yaegashi H, Mizokami A, Akaza H, Namiki M (2013) Japan Cancer of the Prostate Risk Assessment for combined androgen blockade including bicalutamide: clinical application and validation. Int J Urol 20(7):708–714CrossRefPubMedGoogle Scholar
  10. 10.
    Shiota M, Yokomizo A, Takeuchi A, Imada K, Kiyoshima K, Inokuchi J, Tatsugami K, Naito S (2015) The oncological outcome and validation of Japan Cancer of the Prostate Risk Assessment score among men treated with primary androgen-deprivation therapy. J Cancer Res Clin Oncol 141(3):495–503CrossRefPubMedGoogle Scholar
  11. 11.
    Yamaguchi Y, Hayashi Y, Ishizuya Y, Takeda K, Nakai Y, Arai Y, Nakayama M, Kakimoto K, Nishimura K (2015) A single-center study on predicting outcomes of primary androgen deprivation therapy for prostate cancer using the Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score. Jpn J Clin Oncol 45(2):197–201CrossRefPubMedGoogle Scholar
  12. 12.
    Akaza H, Hinotsu S, Usami M, Ogawa O, Kitamura T, Suzuki K, Tsukamoto T, Naito S, Namiki M, Hirao Y, Murai M (2013) Evaluation of primary androgen deprivation therapy in prostate cancer patients using J-CAPRA risk score. Prostate Int 1(2):81–88PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Mastuoka T, Kawai K, Kimura T, Kojima T, Onozawa M, Miyazaki J, Nishiyama H, Hinotsu S, Akaza H (2014) Long-term outcomes of combined androgen blockade therapy in stage IV prostate cancer. J Cancer Res Clin Oncol 141(4):759–765Google Scholar
  14. 14.
    Sugihara T, Yu C, Kattan MW, Yasunaga H, Ihara H, Onozawa M, Hinotsu S, Akaza H (2014) Long-term survival of extremely advanced prostate cancer patients diagnosed with prostate-specific antigen over 500 ng/mL. Jpn J Clin Oncol 44(12):1227–1232CrossRefPubMedGoogle Scholar
  15. 15.
    Hussain M, Tangen CM, Higano C, Schelhammer PF, Faulkner J, Crawford ED, Wilding G, Akdas A, Small EJ, Donnelly B, MacVicar G, Raghavan D, Southwest Oncology Group Trial 9346 (INT-0162) (2006) Absolute prostate-specific antigen value after androgen deprivation is a strong independent predictor of survival in new metastatic prostate cancer: data from southwest oncology group trial 9346 (INT-0162). J Clin Oncol 24(24):3984–3990CrossRefPubMedGoogle Scholar
  16. 16.
    Kwak C, Jeon SJ, Park MS, Lee E, Lee SE (2002) Prognostic significance of the nadir prostate specific antigen level after hormone therapy for prostate cancer. J Urol 168(3):995–1000CrossRefPubMedGoogle Scholar
  17. 17.
    Morote J, Trilla E, Esquena S, Abascal JM, Reventos J (2004) Nadir prostate-specific antigen best predicts the progression to androgen-independent prostate cancer. Int J Cancer 108(6):877–881CrossRefPubMedGoogle Scholar
  18. 18.
    Kitagawa Y, Ueno S, Izumi K, Mizokami A, Hinotsu S, Akaza H, Namiki M (2014) Nadir prostate-specific antigen (PSA) level and tome to PSA nadir following primary androgen deprivation therapy as independent prognostic factors in a Japanese large-scale prospective cohort study (J-CaP). J Cancer Res Clin Oncol 140(4):673–679CrossRefPubMedGoogle Scholar
  19. 19.
    International Union Against Cancer (1997) Urologic Tumors: Prostate. In: Sobin LH, Wittekind CH (eds) TNM Classification of Malignant Tumours, 5th edn. Wiley, New York, pp 170–173Google Scholar
  20. 20.
    Choueiri TK, Xie W, D’Amico AV, Ross RW, Hu JC, Pomerantz M, Regan MM, Taplin ME, Kantoff PW, Sartor O, Oh WK (2009) Time to prostate-specific antigen nadir independently predicts overall survival in patients who have metastatic hormone-sensitive prostate cancer treated with androgen-deprivation therapy. Cancer 115(5):981–987PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Usami M, Akaza H, Arai Y, Hirano Y, Kagawa S, Kanetake H, Naito S, Sumiyoshi Y, Takimoto Y, Terai A, Yoshida H, Ohashi Y (2007) Bicalutamide 80 mg combined with a luteinizing hormone-releasing hormone agonist (LHRH-A) versus LHRH-A monotherapy in advanced prostate cancer: findings from a phase III randomized, double-blind, multicenter trial in Japanese patients. Prostate Cancer Prostat Dis 10(2):194–201CrossRefGoogle Scholar
  22. 22.
    Akaza H, Hinotsu S, Usami M, Arai Y, Kanetake H, Naito S, Hirao Y, Study Group for the Combined Androgen Blockade Therapy of Prostate Cancer (2009) Combined androgen blockade with bicalutamide for advanced prostate cancer: long-term follow-up of a phase 3, double-blind, randomized study for survival. Cancer 115(15):3437–3445CrossRefPubMedGoogle Scholar
  23. 23.
    Hori S, Jabbar T, Kachroo N, Vasconcelos JC, Robson CN, Gnanapragasam VJ (2011) Outcomes and predictive factors for biochemical relapse following primary androgen deprivation therapy in men with bone scan negative prostate cancer. J Cancer Res Clin Oncol 137(2):235–241CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Yasuhide Kitagawa
    • 1
  • Satoru Ueno
    • 1
  • Kouji Izumi
    • 1
  • Yoshifumi Kadono
    • 1
  • Atsushi Mizokami
    • 1
  • Shiro Hinotsu
    • 2
  • Hideyuki Akaza
    • 3
  • Mikio Namiki
    • 1
  1. 1.Department of Integrative Cancer Therapy and Urology, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
  2. 2.Center of Innovative Clinical MedicineOkayama UniversityOkayamaJapan
  3. 3.Department of Strategic Investigation on Comprehensive Cancer Network Research Center for Advanced Science and TechnologyThe University of TokyoTokyoJapan

Personalised recommendations