Abstract | OBJECTIVES: METHODS AND MATERIALS: A retrospective cohort study of 9,547 patients who underwent treatment for prostate cancer was conducted using the Center for Prostate Disease Research Multi-center National Database. From the entire cohort, 347 were found to have CRPC and, of those, 165 had 2 or more AP measurements during follow-up. To determine the AP velocity (APV), the slope of the linear regression line of all AP values was plotted over time. Rapid APV was defined as the uppermost quartile of APV values, which was found to be ≥6.3 IU/l/y. CRPC was defined as 2 consecutive rising PSA values after achieving a PSA nadir<4 ng/ml and documented testosterone values less than 50 ng/dl. The primary study outcomes included bone metastasis-free survival (BMFS) and overall survival (OS). RESULTS: Rapid APV and PSA doubling time (PSADT) less than 10 months were strong predictors of both BMFS and OS in a multivariable analysis. Faster PSADT was a stronger predictor for BMFS (odds ratio [OR] = 12.1, P<0.0001 vs. OR = 2.7, P = 0.011), whereas rapid APV was a stronger predictor of poorer OS (OR = 5.11, P = 0.0001 vs. OR = 3.98, P = 0.0034). In those with both a rapid APV and a faster PSADT, the odds of developing bone metastasis and death exceeded 50%. CONCLUSION: APV is an independent predictor of OS and BMFS in patients with CRPC. APV, in conjunction with PSA-based clinical parameters, may be used to better identify patients with CRPC who are at the highest risk of metastasis and death. These findings need validation in prospective studies.
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Authors | Adam R Metwalli, Inger L Rosner, Jennifer Cullen, Yongmei Chen, Timothy Brand, Stephen A Brassell, James Lesperance, Christopher Porter, Joseph Sterbis, David G McLeod |
Journal | Urologic oncology
(Urol Oncol)
Vol. 32
Issue 6
Pg. 761-8
(Aug 2014)
ISSN: 1873-2496 [Electronic] United States |
PMID | 24929891
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, U.S. Gov't, Non-P.H.S.)
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Copyright | Published by Elsevier Inc. |
Chemical References |
- Androgen Antagonists
- Alkaline Phosphatase
- Prostate-Specific Antigen
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Topics |
- Aged
- Alkaline Phosphatase
(metabolism)
- Androgen Antagonists
(therapeutic use)
- Bone Neoplasms
(diagnosis, secondary)
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Kinetics
- Male
- Middle Aged
- Multivariate Analysis
- Outcome Assessment, Health Care
(methods, statistics & numerical data)
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Prostate-Specific Antigen
(analysis)
- Prostatic Neoplasms, Castration-Resistant
(drug therapy, metabolism, pathology)
- Retrospective Studies
- Risk Factors
- Time Factors
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