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Time to an undetectable prostate‐specific antigen (PSA) after androgen suppression therapy for postoperative or postradiation PSA recurrence and prostate cancer‐specific mortality
Author(s) -
D'Amico Anthony V.,
McLeod David G.,
Carroll Peter R.,
Cullen Jennifer,
Chen MingHui
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22550
Subject(s) - medicine , prostate cancer , interquartile range , hazard ratio , prostate specific antigen , urology , prostate , androgen deprivation therapy , confidence interval , oncology , cancer , radiation therapy , gynecology
BACKGROUND For men receiving androgen‐suppression therapy (AST) for a rising postoperative or postradiation prostate‐specific antigen (PSA) recurrence, whether the time to an undetectable (u) PSA was significantly associated with prostate cancer‐specific mortality (PCSM) was evaluated. METHODS The study cohort comprised 585 men with a rising PSA and negative bone scan after surgery (n = 415) or radiation therapy (n = 170) that were treated with AST and achieved a uPSA. Gray's regression was used to evaluate whether the time to a uPSA after AST was significantly associated with the time to PCSM after the uPSA adjusting for known prognostic factors. RESULTS The median time (interquartile range) to achieve a uPSA was 4.6 (range, 2.8–7.8) months. There were 23 deaths, 4 of which were from prostate cancer. An increasing time to a uPSA (adjusted hazard ratio [HR]: 9.2, 95% confidence interval [CI]: 3.8, 22.1; P < .0001), a decreasing PSA doubling time (DT) (HR: 0.58, 95% CI: 0.43, 0.80; P = .0007), and Gleason score 8 to 10 cancers (HR: 8.6, 95% CI: 1.04, 77; P = .05) were significantly associated with a shorter time to PCSM. CONCLUSIONS Despite achieving a uPSA after AST, the risk of PCSM increased significantly as the time to the uPSA lengthens, especially in men with a short pre‐AST PSA DT and high‐grade prostate cancer. These men should be considered for randomized studies evaluating immediate vs delayed chemotherapy after the achievement of the uPSA. Cancer 2007. © 2007 American Cancer Society.