576 PRETREATMENT PSA GROWTH PATTERN PREDICTS EARLY DEATH AFTER CHEMOTHERAPY IN PATIENTS WITH ANDROGEN-INDEPENDENT PROSTATE CANCER (2010)

You have accessJournal of UrologyProstate Cancer: Advanced I1 Apr 2010576 PRETREATMENT PSA GROWTH PATTERN PREDICTS EARLY DEATH AFTER CHEMOTHERAPY IN PATIENTS WITH ANDROGEN-INDEPENDENT PROSTATE CANCER Kyung Seok Han, Young Deuk Choi, Young Hoon Lee, Seung Choul Yang, and Sung Joon Hong Kyung Seok HanKyung Seok Han More articles by this author , Young Deuk ChoiYoung Deuk Choi More articles by this author , Young Hoon LeeYoung Hoon Lee More articles by this author , Seung Choul YangSeung Choul Yang More articles by this author , and Sung Joon HongSung Joon Hong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.835AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with castration resistant prostate cancer (CRPC) have heterogeneous patterns of the change in prostate-specific antigen (PSA) levels before chemotherapy. The PSA doubling time can be useful for assessing the different patterns of PSA, according to the measurement interval. Therefore, we assessed the PSA patterns using the PSA doubling times for two different intervals and the prognostic significance in CRPC patients. METHODS PSA was measured before chemotherapy and serially during follow-up for at least 9 months after chemotherapy began in 48 CRPC patients. The PSA doubling times were calculated using PSA values for two different periods. The first period was from the first rise greater than the nadir during androgen-deprivation therapy until the start of androgen withdrawal (PSADT1), and the second was from the rise after androgen withdrawal until the start of chemotherapy (PSADT2). All PSA values used in the calculation were 0.2 ng/ml or greater. The PSA pattern was analyzed using the ratio of PSADT1 to PSADT2. Early death was defined as a cancer death less than 9 months after starting chemotherapy. RESULTS The median age was 68 years (range 54-84). The PSA at diagnosis, nadir PSA, and PSA at the onset of chemotherapy were 225 (3.5-12467), 2.8 (0.05-262), and 47.3 (2.17-75,000) ng/ml, respectively. The median values of PSADT1 and PSADT2 were 2.31 (0.25-27.38) and 1.76 (0.06-12.46) months, respectively. Two growth patterns existed when considering the ratio of two PSADTs: 21 patients (43.8%) had a steady pattern with a ratio less than one and 27 patients (56.2%) had an accelerating pattern with a ratio greater than one. Fifteen patients (31.3%) died within 9 months of starting chemotherapy. Univariate analyses showed that the PSA pattern was the only parameter associated with early death (p=0.018, OR=0.167) and multivariate analysis demonstrated that the PSA pattern was the only independent predictor of early death during chemotherapy (p=0.023, OR=0.103). CONCLUSIONS In CRPC patients, two PSA patterns are seen before beginning chemotherapy: the steady and accelerating patterns. Patients with accelerating changes in PSA have a low risk of early death during chemotherapy, as compared to those with a steady change. Seoul, Republic of Korea© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e226 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyung Seok Han More articles by this author Young Deuk Choi More articles by this author Young Hoon Lee More articles by this author Seung Choul Yang More articles by this author Sung Joon Hong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...