Hormone therapy or Primary androgen deprivation therapy (PADT) is the usual first “go to” therapy for men when they are diagnosed with metastatic prostate cancer whether it is a primary diagnosis or the result of a recurrence. The natural progression of the disease is to become unresponsive to the treatment (castrate resistant) leading to a cascading use of other treatments which themselves will also fail.
This progression is serious and will eventually become fatal. Understanding the prognostic factors that could predict prognosis over time could help physician structure treatments and help a man plan out his life.
To better understand some prognostic factors for these events researchers evaluated two hundred eighty-six men with metastatic prostate cancer who received PADT from 1998 to 2005.
They statistically evaluated the predictive factors for the development of castration-resistant prostate cancer (CRPC) and for overall survival.
The median age, follow-up period and PSA level at diagnosis were 73 years, 47 months and 174 ng/mL, respectively. The 5-year overall survival rate was 63.0%. The multivariable analysis showed that Gleason score (Hazard ratio
WHAT THIS MEANS
Nadir PSA (The PSA nadir is the absolute lowest level that the PSA drops after treatment) and the time from beginning PADT to achieving nadir were factors that affect both the development of castrate resistant prostate cancer (CRPC) and to overall survival. The lower nadir PSA level and longer time from PADT to nadir were good for survival and progression.
WHAT WAS CONSIDERED LOW/MEDIUM AND HIGH NADIRS
Low – <0.2 ng/mL
Medium- 0.2-4 ng/mL
High – ?4 ng/mL)
WHAT WAS CONSIDERED SLOW/MEDIUM AND QUICK TIMES TO ACHIEVING NADIR
Slow- ?12 months vs.
Medium- 6–12 months vs.
Quick- <6 months)
BMC Urol 2014 Apr 29;14(1):33. doi: 10.1186/1471-2490-14-33: Tomioka A1, Tanaka N, Yoshikawa M, Miyake M, Anai S, Chihara Y, Okajima E, Hirayama A, Hirao Y, Fujimoto K.
Joel T. Nowak, M.A., M.S.W.
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