KMID : 0358320120530090607
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Korean Journal of Urology 2012 Volume.53 No. 9 p.607 ~ p.613
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Prostate-Specific Antigen Nadir and Time to Prostate-Specific Antigen Nadir Following Maximal Androgen Blockade Independently Predict Prognosis in Patients with Metastatic Prostate Cancer
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Hong Seok-Young
Cho Dae-Sung Kim Sun-Il Ahn Hyun-Soo Kim Se-Joong
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Abstract
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Purpose: To evaluate the influence of prostate-specific antigen (PSA) kinetics following maximal androgen blockade (MAB) on disease progression and cancer-specific survival in patients with metastatic, hormone-sensitive prostate cancer.
Materials and Methods: One hundred thirty-one patients with metastatic, hormone-sensitive prostate cancer treated with MAB at our institution were included in this study. Patients¡¯ characteristics, PSA at MAB initiation, PSA nadir, time to PSA nadir (TTN), and PSA decline were analyzed by using univariate and multivariate analysis.
Results: At a median follow-up of 30 months, 97 patients (74.0%) showed disease progression and 65 patients (49.6%) died. Fifty-nine patients (45.0%) died from prostate cancer. In the univariate analysis, PSA at MAB initiation, PSA nadir, TTN, and PSA decline were significant predictors of progression-free survival. Also, PSA nadir, TTN, and PSA decline were significant predictors of cancer-specific survival. In the multivariate analysis, higher PSA nadir (¡Ã0.2 ng/ml) and shorter TTN (<8 months) were independent predictors of shorter progression-free and cancer-specific survival. In the combined analysis of PSA nadir and TTN, patients with higher PSA nadir and shorter TTN had the worst progression-free survival (hazard ratio [HR], 14.098; p<0.001) and cancer-specific survival (HR, 14.050; p<0.001) compared with those with lower PSA nadir and longer TTN.
Conclusions: Our results suggest that higher PSA nadir level and shorter TTN following MAB are associated with higher risk of disease progression and poorer survival in patients with metastatic, hormone-sensitive prostate cancer. Furthermore, these two variables have a synergistic effect on the outcome.
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KEYWORD
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Prognosis, Prostate-specific antigen, Prostatic neoplasms
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