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

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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.

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Acknowledgments

We thank Dr. Michiyuki Usami, Dr. Osamu Ogawa, Dr. Tadaichi Kitamura, Dr. Kazuhiro Suzuki, Dr. Taiji Tsukamoto, Dr. Seiji Naito, Dr. Yoshihiko Hirao, Dr. Masaru Murai, and the Japan Study Group of Prostate Cancer (J-CaP) for providing clinical data from the J-CaP.

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Authors and Affiliations

  1. Department of Integrative Cancer Therapy and Urology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8640, Japan

    Yasuhide Kitagawa, Satoru Ueno, Kouji Izumi, Yoshifumi Kadono, Atsushi Mizokami & Mikio Namiki

  2. Center of Innovative Clinical Medicine, Okayama University, Okayama, Japan

    Shiro Hinotsu

  3. Department of Strategic Investigation on Comprehensive Cancer Network Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan

    Hideyuki Akaza

Authors
  1. Yasuhide Kitagawa
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  2. Satoru Ueno
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  3. Kouji Izumi
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  4. Yoshifumi Kadono
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  5. Atsushi Mizokami
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  6. Shiro Hinotsu
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  7. Hideyuki Akaza
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  8. Mikio Namiki
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Corresponding author

Correspondence to Yasuhide Kitagawa.

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Conflict of interest

The authors have no conflict of interest.

Ethical standard

This study has been approved by Japanese multicenter institutional review board for research (UMIN 000000570). There is no patient identifying information included in this manuscript.

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Kitagawa, Y., Ueno, S., Izumi, K. et al. Clinical outcomes and nadir prostate-specific antigen (PSA) according to initial PSA levels in primary androgen deprivation therapy for metastatic prostate cancer. World J Urol 34, 319–327 (2016). https://doi.org/10.1007/s00345-015-1621-5

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  • DOI: https://doi.org/10.1007/s00345-015-1621-5

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