Dynamic changes in PSA levels predict prognostic outcomes in prostate cancer patients undergoing androgen -deprivation therapy: A multicenter retrospective analysis

Abstract

BackgroundAndrogen-deprivation therapy (ADT) is used for the treatment of prostate cancer. However, the specific risk factors for the development of castration-resistant disease are still unclear. The present study sought to identify predictors of patient prognostic outcomes through analyses of clinical findings in large numbers of prostate cancer patients following ADT treatment.MethodsData pertaining to 163 prostate cancer patients treated at the Second Affiliated Hospital of Bengbu Medical University and Maoming People’s Hospital from January 1, 2015, to December 30, 2020, were retrospectively analyzed. Dynamic changes in prostate-specific antigen (PSA) levels were regularly assessed, including both time to nadir (TTN) and nadir PSA (nPSA). Univariate and multivariate analyses were performed with Cox risk proportional regression models, while differences in biochemical progression-free survival (bPFS) were compared among groups with Kaplan-Meier curves and log-rank tests.ResultsThe bPFS values over the median 43.5-month follow-up period differed significantly between patients with nPSA levels < 0.2 ng/mL and ≥ 0.2 ng/mL, being 27.6 months and 13.5 months, respectively (log-rank P < 0.001). A significant difference in median bPFS was also observed when comparing patients with a TTN ≥ 9 months (27.8 months) to those with a TTN < 9 months (13.5 months) (log-rank P < 0.001).ConclusionsTTN and nPSA are valuable predictors of prognosis in prostate cancer patients after ADT treatment, with better outcomes evident in patients with nPSA < 0.2 ng/mL and TTN > 9 months.

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“…The study revealed that both nPSA and TTN were significant prognostic factors for the progression to CRPC in patients with mHSPC. Furthermore, patients with nPSA levels of ≤ 0.2 ng/ml and TTN ≥ 9 months significantly delayed disease progression and prolonged OS (29,30). However, there is no conclusive evidence to determine whether these two measures significantly improve or worsen patient outcomes, and their specific impact on patient prognosis remains unknown.…”

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“…False positive results of PSA screening, and prostatic puncture will cause overexamination and over-treatment, which undoubtedly increases the psychological pressure and medical expenses for the patients [19]. When the PSA levels exceeds 4.0 ng • ml -1 or DRE result is abnormal, it usually suggestive of Pca, but the standards may change along with the changes in age, race and personal physiological conditions [20]. PSA detection is unable to distinguish between BPH or Pca.…”

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“…However, the tumors in some ADT-treated patients eventually progressed to a more aggressive form, called castration-resistant PCa (CRPC). CRPC exhibits a significant increase in prostate-specific antigen (PSA) value and/or radiographic progression despite castration [3,4]. Currently, the approved therapies for CRPC include chemotherapy, immunotherapy, radiation therapy, targeted therapies and hormone therapies (i.e., by AR inhibitors) [5].…”