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Japanese Journal of Clinical Oncology 2008 38(1):36-42; doi:10.1093/jjco/hym153
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The Authors (2008). Published by Oxford University Press. All rights reserved
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Outcome of Patients with Hormone-Refractory Prostate Cancer: Prognostic Significance of Prostate-Specific Antigen-Doubling Time and Nadir Prostate-Specific Antigen

Susumu Tomioka1, Masashi Shimbo1, Yoshiyasu Amiya1, Hiroomi Nakatsu1, Shino Murakami1 and Jun Shimazaki2,

1 Department of Urology, Asahi General Hospital, Asahi, Chiba, Japan
2 Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan

For reprints and all correspondence: Jun Shimazaki, Department of Urology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi 260-8670, Japan. E-mail: shimajun{at}opal.famille.ne.jp

Received August 6, 2007; accepted September 27, 2007

Objective: Most patients with advanced prostate cancer after prostate-specific antigen (PSA) relapse following maximum androgen blockade rapidly progress to death. The present study was aimed to predict the survival of these serious patients after PSA relapse.

Methods: Sixty-eight patients with M1b and 20 patients with T3b, who relapsed and died of cancer within a short period, were studied. PSA-doubling time (PSA-DT) at PSA relapse influenced the outcome after PSA relapse [hazard ratio (CI): 2.000 (1.283–3.226)]; thus, on the basis of the median values of PSA-DT (>2 months) and additionally nadir PSA in previous treatment (≤2 ng/ml), patients were stratified into four groups. Outcome in the respective groups was examined.

Results: The patients with PSA-DT of >2 months and nadir PSA of ≤2 ng/ml showed the longest survival. The other patients in various classifications proceeded with the similarly worse outcomes, in which PSA-DT still influenced survival [hazard ratio (CI): 0.422 (0.203–0.878)]. In several treatments, estramustine phosphate and dexamethasone were relatively effective. A similar rate of response to these drugs was obtained in all four groups, irrespective of stratifying with PSA-DT and nadir PSA, and this may be possibly due to the intervals between relapse and treatments, in which tumor volume was increased and tumor property was altered. Patients responding to treatment showed prolonged survival.

Conclusion: Both PSA-DT and nadir PSA were predictive factors for subsequent survival at PSA relapse, and the patients with long PSA-DT and low nadir PSA may show long outcome.

Key Words: prostate cancer • hormone-refractory cancer • PSA-doubling time • nadir PSA • PSA relapse


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