在轉移性荷爾蒙抗性攝護腺癌使用ARTA的短期預後因子探討
李宗霖1、劭翊紘1、張英勛1、虞凱傑1、莊正鏗1、馮思中1
林口長庚醫院外科部泌尿科;
PSA kinetics parameter in prediction of progression of mCRPC
Tsung-Lin Lee 1, I-Hung Shao 1,Ying-Hsu Chang 1, Yu, Kai-Jie, Cheng-Keng Chuang1
See-Tong Pang1
1 Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 33302, Taiwan
Purpose: prostate cancer(PC) was one of the most prevalence cancer diagnosis in Taiwan. Meanwhile, Abiraterone Acetate and Enzalutamide were approve by NIH as the first line treatment of metastatic castration-resistant prostate cancer (mCRPC). However, NIH has changed their policy of approving usage of ARTA in these years , changing strategy of doctor in choosing agent between chemotherapy and ARTA while patient progressing from CSPC to CRPC. Thus, these situations separate two group by times which were Chemo-naïve CRPC and Post-Chemotherapy CRPC. We report cohort study in comparing overall survival in these two group in using ARTA , and predictor of progression of CRPC in these two group in using ARTA.
Materiral and methods: From December 2015 to Arial 2019, we retrospectively included 119 patients who received abiraterone and enzalutamide due to mCRPC . Among them, 62 patients received ARTA before using chemotherapy(chemo-naïve) . General characteristics data including age, initial PSA, initial Hb, N/L ratio and malignancy character include staging, Gleason score, PSA doubling time were reviewed.
We also collected PSA data monthly after diagnosis of mCRPC. Parameter were selected included PSA maximum decline, time to PSA nadir, time to progression . Statistical analysis was performed with Statistical product and service solutions (SPSS)
Results: The mean age of the patients using ARTA was 74.5 years, with initial PSA 768.7. By examining out come with Time to PSA progression, There was no signification between Time to CRPC and Time to PSA progression(TTPP). However, Time to nadir has significant relation with TTPP (T=30.5, P<0.05), revealing that longer duration of PSA declining has a better prognosis. Although Maximum decline of PSA has no significant relationship with TTPP (p=0.08), this might be related to limited sample size.
Conclusion
In real world study, response of ARTA differ from individual to individual. ARTA will eventually fail in treating mCRPC. In our study, we discover Time to nadir was strong predictor of PSA progression. This conclusion might change physician strategy in monitor PSA after using ARTA.