轉移性前列腺癌病人接受雄性素剝奪治療中腫瘤容量,前列腺特異抗原下降至最低點的時間以及前列腺特異抗原下降速率的影響
林晏頎、甘弘成、劉忠一、邵翊紘、林柏宏、虞凱傑、張英勛、馮思中、莊正鏗
林口長庚紀念醫院外科部泌尿外科, 長庚大學
Tumor Volume, time to PSA nadir and PSA decline rate influence outcomes in metastatic prostate cancer receiving androgen deprivation therapy
Yen-Chi Lin , Hung-Cheng Kan , Chung-Yi Liu , I-Hung Shao , Po-Hung Lin , Kai-Jie Yu ,
Ying-Hsu Chang , See-Tong Pang, Cheng-Keng Chuang
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
Purpose: Androgen deprivation therapy (ADT) has long been the gold standard for the patients with metastatic hormone-sensitive cancer (mHSPC) in the past. "Tumor volume", a new classification of metastatic prostate cancer (mPCa), is defined as high-volume and low-volume. According to CHAARTED trial or GETUG-AFU 15, high volume mHSPC had better response for chemohormone therapy. Nevertheless, factors influencing tumor volume in the disease progression is still unclear, we analyze the relationship of tumor volume, PSA decline rate and duration of PSA nadir in newly diagnosed mHSPC patients on ADT in Chang Gung Memorial Hospital.
Materials and Methods: We retrospectively studied patients with newly diagnosed metastatic prostate cancer between 2007 and 2016 who had been treated with ADT (either surgical or medical castration, with or without anti-androgen) The patients were grouped into high-volume disease (HVD) and low-volume disease (LVD) according to CHAARTED trial, High-volume disease (HVD) was defined as presence of visceral metastases and/or ≥ four bone metastases with at least one outside of the vertebral column and pelvis. Patients who didn’t fit the above definition were classified as the low volume disease (LVD). Other prognosis-related parameters including PSA kinetics were also analyzed.
Results: From January 2007 to December 2016, a total 648 newly diagnosed mPCa patients were recruited for analysis. Median age was 75 years old (46 to 97 y/o). Among them, 352 patients (54%) were classified as HVD and 296 patients (46%) were LVD. Median initial PSA level (iPSA) was 511.51 ng/ml (range, 10.6 to 23125.5 ng/ml) in HVD group and 98.194 ng/ml (range, 6.94 to 5123 ng/ml) in LVD group. The median time to the development of biochemical CRPC was significantly shorter in patients with HVD than LVD (11.5 months vs. 24.5 months, P<0.001). The median time from ADT to PSA nadir was 7.3 months vs. 12.1 months in HVD group and LVD group, and the mean duration of PSA nadir was 8 months vs. 17.85 months respectively.( P<0.001)
Conclusion: High volume metastatic prostate cancer had shorter time from ADT to PSA nadir, higher PSA decline rate and longer duration of PSA nadir, but they developed CRPC earlier and shorter OS.