Effect of Prior Local Treatment and Prostate-specific Antigen Kinetics during Androgen-deprivation Therapy - Beyond the Abstract

Prostate cancer (PCa) shows a protracted natural history with heterogeneous outcomes, depending on the treatment modality. In order to deliver optimal treatment and maximize survival outcomes, it is imperative to identify clinical predictors that can distinguish high-risk patients who may be candidates for active treatment from low-risk patients who can be offered less aggressive therapy.

So far, no study has analyzed the prognostic impact of PSA kinetics during androgen deprivation therapy on prostate cancer-specific survival (PCSS) in patients stratified according to their prior history of local tumor treatment, and who later received various novel approved agents targeting castration-resistant PCa (CRPC). To address this issue, we investigated the utility of PSA kinetics during ADT, according to the prior local therapy with curative intent, for the prediction of cancer-specific survival (CSS) in patients with CRPC.

Our results provide meaningful data indicating that disease progression may be affected by the treatment of the primary tumor. Furthermore, PSA kinetics, including time to PSA nadir and time to CRPC onset during ADT, cannot be utilized as an independent prognostic marker in all patients but should be interpreted according to previous local treatment of the primary tumor. Further larger-scale analyses are warranted to define the influence of local treatment on ADT pharmacokinetics and on the future response to CRPC treatment.

Written by: Yoon Soo Hah, MD, Department of Urology, Daegu Catholic University Medical Center, Daegu, Republic of Korea and Kyo Chul KOO, MD, PhD, Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

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