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Journal List > Korean J Urol > v.48(4) > 1004899

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Park, Choi, Kim, Hong, Kim, Lee, Song, Yoon, and Rim: Predictive Variables of the Progression to Androgen Independent Prostate Cancer after Combined Androgen Blockade
Original Article

Korean J Urol 2007;48(4):408-415.

Published online: 18 December 2007

DOI: https://doi.org/10.4111/kju.2007.48.4.408

Predictive Variables of the Progression to Androgen Independent Prostate Cancer after Combined Androgen Blockade

Seung Chol Park, Han Yong Choi1, Choung Soo Kim2, Sung Joon Hong3, , Wun Jae Kim4, Sang Eun Lee5, Jae Mann Song6, Jin Han Yoon7, Joung S ik Rim

1From the Department of Urology, Wonkwang University, Iksan

2Sungkyunkwan University, Seoul

3University of Ulsan, Ulsan

4Yonsei University, Seoul,

5Chungbuk National University, Cheongju

6Seoul National University, Seongnam,

7Yonsei University Wonju College of Medicine, Wonju

8Dong-A University College of Medicine, Busan, Korea

Corresponding Author: Jeongsik Lim Department of Urology, Wonkwang University Hospital 344-2, Sinyong-dong, Iksan-si, Jeollabuk-do 570-711 TEL: 063-850-1331 FAX: 063-842-1455 E-mail: jsrim@wonkwang.ac.kr

Received 14 February 2007       Accepted 26 March 2007

Copyright © 2007 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Despite of the effectiveness of androgen deprivation therapy for prostate cancer, it progress to androgen independent prostate cancer (AIPC) after various periods of time. The objective of this study was to analyze the clinical and pathological variables that predict progression to AIPC after combined androgen blockade (CAB).

Materials and Methods:

MMHriMlBflieMMIkBdhl We retrospectively reviewed the medical records of 343 patients who were treated with CAB for prostate cancer. Binary logistic regression test was used to analyze the independent predictors for the progression to AIPC. The time to AIPC, according to variables, was assessed by the Kaplan-Meier method and the variables were compared using the Log-Rank test.

Results:

RHuHH The mean follow-up was 42.1 months (range: 12-120). Seventy seven patients (33.3%) experienced progression to AIPC at a median of 20.2 months (range: 6-72). On univariate analysis, the percentage of positive prostate biopsies, the Gleason score, the T stage, the extent of bone metastasis, lymph node metastasis, the pretreatment PSA level, the nadir PSA and the PSA level at 3 and 6 months all had a significant relationship with the progression to AIPC. The receiver operating characteristic curve analysis for the nadir PSA showed that the optimal cut-off point to predict progression to AIPC was 0.5ng/ml with an area under curve of 0.769. A multivariate analysis demonstrated that the Gleason score (>7), the nadir PSA (>0.5ng/ml), and the PSA level at 6 months (>4.0ng/ml) were significantly correlated with the progression to AIPC.

Conclusions:

QoirilMklll This study suggested that Gleason score, the nadir PSA and the PSA level at 6 months were independent variables to predict progression to AIPC after CAB. The PSA level at 6 months may be the most accurate variable to predict progression to AIPC.

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Keywords: Prostate cancer, Hormone, Progression

REFERENCES

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kju-48-408f1.tif
Fig. 1.
Study Schema. CAB: combined androgen blockade, AIPC: androgen independent prostate cancer.
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kju-48-408f2.tif
Fig. 2.
Receiver operating characteristics curve analysis of the nadir prostate-specific antigen (PSA) to predict progression to androgen independent prostate cancer. AUC: area under curve.
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kju-48-408f3.tif
Fig. 3.
Time to progression to androgen independent prostate cancer according to the T stage, the extent of bone metastasis, the pretreatment prostate-specific antigen (PSA), the nadir PSA, the PSA level at 3 months and the PSA level at 6 months.
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Table 1.
Baseline descriptive characteristics of the 231 patients
No. of patients 231
Age (years) 74.0 (46-94)
Pretreatment PSA (ng/ml) 231.4±544.1 (1.3-4,610)
Gleason score 7.7 ±1.4 (2-10)
T stage  
 1-2 (%) 120 (51.9)
 3-4 (%) 111 (48.1)
Lymph node metastasis (%) 84 (36.4)
Bone metastasis (%) 107 (46.3)
Lung metastasis (%) 7 (3.0)
CAB  
 Orchiectomy + antiandrogen (%) 5(2.1)
 Goserelin +antiandrogen (%) 172 (74.5)
 Leuprolide + antiandrogen (%) 54 (23.4)

PSA: prostate-specific antigen, CAB: combined androgen blockade

Table 2.
Univariate analysis of the quantitative variables according to the progression to androgen independent prostate cancer
  Progression to AIPC p-value
No (n=154) Yes (n=77)
Age (year) 75.5 ±8.3 71.1 ±7.4 <0.001
BMI 22.8 ±2.6 22.8±3.1 0.924
Pretreatment PSA (ng/ml) 198.7 ±581.6 298.1 ±454.5 0.193
% positive core 71.7±31.8 85.2 ±24.3 0.003
Gleason score 7.6±1.4 8.2±1.2 0.001
Hemoglobin (g/dl) 13.1 ±1.6 12.7±1.9 0.210
Alkaline phosphatase 123.1 ±72.6 336.8±1,013.9 0.070
Nadir PSA (ng/ml) 0.9 ±3.9 5.9±11.1 < 0.001
Time to nadir PSA (month) 8.2 ±4.1 9.0 ±5.2 0.282
PSA at 3 months (ng/ml) 6.3 ±16.5 26.1 ±64.9 0.014
PSA at 6 months (ng/ml) 2.2 ±7.2 25.8 ±102.5 0.058

AIPC: androgen independent prostate cancer, BMI: body mass index, PSA: prostate-specific antigen

Table 3.
Univariate analysis of the distribution of qualitative variables according to the progression to androgen independent prostate cancer
Progression to AIPC p-value
No (n=154) Yes (n=77)
T stage      
 1 46 12  
 2 50 12 < 0.001
 3 43 30  
 4 15 23  
N stage      
 0 113 34  
 1 41 43 < 0.001
Number lymph node      
 Single 127 40 < 0.001
 Multiple 27 37  
Bone metastasis      
 No 90 25  
 Central 27 17 0.001
 Peripheral 37 35  
Pretreatment PSA (ng/ml)      
 <10 22 5  
 >10, <100 79 30 0.007
 >100 53 42  
Nadir PSA (ng/ml)      
 <0.5 115 34  
 > 0.5 39 43 < 0.001
PSA at 3 months (ng/ml)      
 <4.0 105 40  
 > 4.0 49 37 0.013
PSA at 6 months (ng/ml)      
 <4.0 139 44  
 > 4.0 15 33 < 0.001

AIPC: androgen independent prostate cacer, PSA: prostate-specific antigen

Table 4.
Binary logistic regression analysis of the predictive variables of androgen independent prostate cancer
Variables Odd ratio 95% CI for Exp (B) p-value
Pretreatment PSA (ng/ml)      
 <10 1.000    
 >10, < 100 0.460 0.127-1.665 0.237
 >100 0.361 0.089-1.467 0.154
Gleason score      
 <7 1.000    
 >7 2.405 1.051-5.503 0.038
T stage      
 1 1.000    
 2 0.500 0.158-1.579 0.238
 3 1.637 0.551-4.864 0.375
 4 2.351 0.667-8.285 0.183
LN metastasis      
 No 1.000    
 Metastasis 1.157 0.489-2.734 0.740
Bone metastasis      
 No 1.000    
 Central 1.803 0.704-4.620 0.220
 Peripheral 2.043 0.822-5.073 0.124
Lung metastasis      
 No 1.000    
 Metastasis 0.371 0.042-3.308 0.374
Nadir PSA (ng/ml)      
 < 0.5 1.000    
 > 0.5 2.125 1.045-4.211 0.041
PSA at 3 months (ng/ml)      
 < 4.0 1.000    
 > 4.0 0.537 0.195-1.477 0.229
PSA at 6 months (ng/ml)      
 < 4.0 1.000    
 > 4.0 10.241 3.030-34.614 < 0.001

PSA: prostate-specific antigen, CI: confidence interval

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