To determine if absolute prostate-specific antigen (PSA) value after six months of androgen deprivation treatment (ADT) is predictive of subsequent survival in patients with prostate adenocarcinoma (PCa).
We performed a retrospective review for men receiving care within Veterans Affairs Healthcare System, who initiated ADT for PCa. We used the low (≤0.2 ng/ml), intermediate (0.2 to 4 ng/ml), and high risk (>4 ng/ml) absolute PSA values after 6-9 months of ADT previously described in SWOG 9346. The primary endpoints were all-cause mortality and prostate cancer-specific mortality (PCSM). Kaplan Meier survival curves for each PSA category was estimated and log-rank test was conducted. We employed Cox regression analysis adjusted for covariates and inverse propensity score weights associated with PSA categories to estimate the PSA category's association with PCSM and all-cause mortality.
We identified 9,170 patients in our cohort. Following ADT induction, 3,508 patients had low, 3,419 had intermediate, and 2,243 had high PSA values. Two- and five-year survival rates for low, intermediate, and high PSA groups were 93.9% and 85.2% vs. 88.6% and 71.2% vs. 63.6% and 38.6%, respectively (p<0.0001). Patients in the high and intermediate PSA category had 15- and 3-times higher risk of PCSM compared to those with PSA <0.2 ng/mL (p<0.0001).
Absolute PSA in hormone sensitive prostate cancer (HSPC) after six to nine months of ADT is a predictor of overall and PCSM. This measure can rapidly assess the efficacy of new interventions in phase two clinical trials.
The Journal of urology. 2022 Mar 28 [Epub ahead of print]
Furkan Dursun, Chen-Pin Wang, Daniel MacCarthy, Ahmed M Mansour, Deepak Pruthi, Dharam Kaushik, Ian M Thompson, Michael A Liss
University of Texas Health San Antonio, Department of Urology, San Antonio, Texas., South Texas Veterans Health Care System, San Antonio, Texas., CHRISTUS Santa Rosa Health System, San Antonio, Texas.