Early Evaluation of PSA Response in Metastatic Prostate Cancer Treated with Abiraterone
Early Evaluation of PSA Response in Metastatic Prostate Cancer Treated with Abiraterone作者机构：Consorcio Hospitalario Provincial de Castellón Castellón de la Plana Spain
出 版 物：《Open Journal of Urology》 (泌尿学期刊（英文）)
年 卷 期：2021年第11卷第7期
页 面：251-263页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Prostate Cancer Abiraterone Prostate-Specific Antigen Decline Survival
摘 要：Background: According to the main prostate cancer guidelines, the response to treatment with abiraterone plus prednisone (AA+P) must be evaluated by assessing prostate-specific antigen (PSA) levels at 12 weeks. Recent studies have shown that early PSA decline, at 4 weeks, maybe a surrogate marker for survival. The objective of this work was to analyze if a decline in PSA at 4 weeks correlates with a better outcome in terms of OS (overall survival) and PFS (progression-free survival). Methods: We evaluated 168 patients (with a median age of 71 years) with prostate cancer who had started AA+P treatment between February 2012 and July 2019. Patients were divided into three different groups according to the decline of PSA (≥30%, ≥50%, and ≥90%) at 4, 8, and 12 weeks. Statistical survival analysis was performed using the Kaplan-Meier method. Results: After a follow-up of 69 months, a PSA decline ≥ 30% at 4 weeks was associated with longer median OS times (28 vs. 18 months;p = 0.027). A decline in PSA by ≥50% was also associated with increased median OS times (36 vs. 21;p = 0.003). Cox univariable analysis indicated that a decrease in PSA (both by ≥30% and ≥50) were predictive of OS at 4 weeks (PSA ≥ 30%: HR = 1.568, 95%CI [1.041, 2.360], p = 0.031;PSA ≥ 50%: HR = 1.901, 95% CI [1.222, 2.956], p = 0.004);although multivariable analysis did not confirm these results. The prior administration of chemotherapy was an independent risk factor for death (HR = 2.511;p Conclusion: A decrease in PSA by ≥30% or ≥50% at 4 weeks after starting treatment with AA+P correlated with longer PFS and OS, and provides clinically meaningful information guiding the physicians towards a personalized treatment.
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