Reductions in testosterone concentration play a significant role in the treatment of prostate cancer. We studied the role of testosterone as a prognostic marker for advanced prostate cancer (stage C or higher) treated with primary androgen-deprivation therapy (ADT).
A total of 348 patients were treated using ADT as first-line therapy for prostate cancer at Chiba University Hospital between 1999 and 2016. Of these, 222 patients with advanced prostate cancer (stage C or higher) were enrolled onto this study. The prognostic values of serum testosterone level and other clinical factors were evaluated in association with prostate-specific antigen (PSA), progression-free survival during first-line therapy, and overall survival.
Median age was 73 years. PSA at baseline was 86 ng/mL. Gleason scores of ≤ 6, 7, 8, and ≥ 9 were seen in 2.3%, 19.4%, 21.2%, and 41.9%, respectively. Mean follow-up was 60.5 months. Median testosterone at baseline was 482 ng/dL and nadir testosterone was 13 ng/dL. No variable associated with testosterone predicted progression-free survival. With regard to overall survival, multivariate analysis identified nadir testosterone ≤ 20 ng/dL (hazard ratio = 0.44, P = .026) and testosterone reduction ≥ 480 ng/dL (hazard ratio = 0.35, P = .030) as independent prognostic factors. With regard to progression-free survival, multivariate analysis identified nadir PSA ≤ 0.1 ng/mL (hazard ratio = 3.07, P < .001), presence of lymph node metastasis (hazard ratio = 1.67, P = .017), and time to nadir PSA (hazard ratio = 0.30, P < .001) as independent prognostic factors.
Our data suggested both nadir testosterone (< 20 ng/dL; P = .026) and testosterone reduction (≥ 480 ng/dL; P = .030) to be key prognostic factors for primary ADT in advanced prostate cancer in Japanese men.
Clinical genitourinary cancer. 2017 Aug 03 [Epub ahead of print]
Satoshi Yamamoto, Shinichi Sakamoto, Xu Minhui, Takaaki Tamura, Kotaro Otsuka, Kodai Sato, Marghulan Maimaiti, Shuhei Kamada, Akinori Takei, Miki Fuse, Kouji Kawamura, Takashi Imamoto, Akira Komiya, Koichiro Akakura, Tomohiko Ichikawa
Department of Urology, Chiba University Hospital, Chiba, Japan., Department of Urology, Chiba University Hospital, Chiba, Japan. Electronic address: ., Department of Urology, Yokohama Rosai Hospital, Yokohama City, Japan., Department of Urology, Japan Community Healthcare Organization, Tokyo Shinjuku Medical Center, Tokyo, Japan.