A study from a group at Harvard has evaluated the relationship between the rate of PSA decline after initiation of androgen-deprivation therapy (ADT) and overall survival (OS) in men with metastatic, hormone-sensitive prostate cancer (HSPC).
Choueiri et al. used their own institutional database to identify 179 men with metastatic HSPC who were treated with ADT. Patients were included if they had at least two serum PSA determinations before their PSA nadir and at least one serum PSA value available within 1 month of ADT initiation. Patient characteristics, PSA at ADT initiation, nadir PSA, time to PSA nadir (TTN), and PSA decline (PSAD) in relation to OS were analyzed.
The results of this retrospective analysis are as follows:
- The patients had a median follow-up after ADT initiation of 4 years.
- The median OS after ADT initiation was 7 years.
- The median PSA levels at ADT initiation and PSA nadir were 47 and 0.28 ng/ml, respectively.
- On univariate analysis five measures were clearly associated with a shorter OS:
- Time to PSA nadir < 6 months
- PSA doubling time >52 ng/ml per year
- PSA nadir ≥ 0.2 ng/ml
- PSA ≥ 47.2 ng/mL at ADT initiation
- Gleason score >7
- On multivariate analysis just three of these measures were independent predictors of a shorter OS:
- Time to PSA nadir < 6 months
- PSA nadir ≥ 0.2 ng/ml
- Gleason score >7
The authors state that, to their knowledge, this is the first report to demonstrate that a faster time to reach a PSA nadir after the initiation of ADT is associated with shorter survival duration in men with metastatic HSPC. They clearly stress that these results need confirmation. The “New” Prostate Cancer InfoLink would also point out that the form of ADT used may have significant impact on time to PSA nadir, and that the abstract of the paper does not clearly indicate that all patients in the authors’ database received the same form of ADT.
Filed under: Management, Treatment Tagged: | ADT, metastatic hormone-sensitive prostate cancer, survival, time to PSA nadir
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These were men with D1 and D2 disease, significant PSA, most whom did not reach undetectable PSA, and median OS is still 7 years. That is pretty good.
These men include many who reached a nadir quickly, but that nadir was far above what a clinician or patient would expect to make for a long-term successful administration of ADT. Those men whose TTN is less may also reach a higher nadir, and thus have a shorter course to OS. Lower nadir is better, TTN regardless.