Predictors of survival in prostate cancer patients with bone metastasis and extremely high prostate-specific antigen levels

Abstract

PurposeProstate-specific antigen (PSA) is a surrogate marker of disease progression; however, its predictive ability in the extreme ranges is unknown. We determined the predictors of survival in patients with bone metastatic prostate cancer (BMPCa) and with extremely high PSA levels.MethodsTreatment-naïve patients (n = 248) diagnosed with BMPCa between December 2002 and June 2012 were retrospectively analyzed. Clinicopathological features at diagnosis, namely age, body mass index, serum alkaline phosphatase (ALP) and PSA levels, PSA nadir, time to PSA nadir and its maintenance period, PSA declining velocity, Gleason grade, clinical T stage, pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), and the number of bone metastases were assessed. The patients were stratified according to PSA ranges of <20 ng/mL, 20–100 ng/mL, 100–1000 ng/mL, and 1000–10,000 ng/mL. Study endpoints were castration-resistant PCa (CRPC)-free survival and cancer-specific survival (CSS).ResultsPatients with higher PSA and ALP levels showed more bone lesions (P < 0.001). During the follow-up period (median, 39.9 months; interquartile range, 21.5–65.9 months), there were no differences between the groups in terms of the survival endpoints. High ALP levels, shorter time to PSA nadir, and pain were associated with an increased risk of progression to CRPC, and high ALP levels, ECOG PS ≥ 1, and higher PSA nadir independently predicted CSS.ConclusionsPSA response to androgen deprivation therapy and serum ALP are reliable predictors of survival in patients with BMPCa presenting with extremely high PSA levels. These patients should not be deterred from active treatment based on baseline PSA values.

Survival analysis and development of a prognostic nomogram for bone‐metastatic prostate cancer patients: A single‐center experience in Indonesia

“…The suggestion of PSA in the metastatic setting might show the disease burden, as reported in the study by Koo et al . that the PSA value was associated with the number of bone‐metastatic lesions . In the present study, high initial PSA showed a poor prognosis for OS.…”

Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

“…Prostate cancer is a common malignant tumor in the urinary system with increased incidence and mortality in recent years (Chang et al, 2015;Koo et al, 2015). Bone is a common target of distant metastases in prostate cancer (Huang et al, 2015;Mai et al, 2015).…”

Tumour-derived alkaline phosphatase regulates tumour growth, epithelial plasticity and disease-free survival in metastatic prostate cancer

“…These include alkaline phosphatase, bone-specific alkaline phosphatase, urinary n -telopepetide, previous skeletal-related events and pain (Metwalli et al , 2014; Fizazi et al , 2015; Koo et al , 2015). Alkaline phosphatase, also known as tissue nonspecific alkaline phosphatase (TNAP) or mesenchymal stem cell antigen 1, is an enzyme that is expressed by a range of tissues including bone, and also the liver (Buchet et al , 2013).…”