Open Access Highly Accessed Research article

Nadir PSA level and time to nadir PSA are prognostic factors in patients with metastatic prostate cancer

Atsushi Tomioka*, Nobumichi Tanaka, Motokiyo Yoshikawa, Makito Miyake, Satoshi Anai, Yoshitomo Chihara, Eijiro Okajima, Akihide Hirayama, Yoshihiko Hirao and Kiyohide Fujimoto

Author Affiliations

Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan

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BMC Urology 2014, 14:33  doi:10.1186/1471-2490-14-33

Published: 29 April 2014

Abstract

Background

Primary androgen deprivation therapy (PADT) is the most effective systemic therapy for patients with metastatic prostate cancer. Nevertheless, once PSA progression develops, the prognosis is serious and mortal. We sought to identify factors that predicted the prognosis in a series of patients with metastatic prostate cancer.

Methods

Two-hundred eighty-six metastatic prostate cancer patients who received PADT from 1998 to 2005 in Nara Uro-Oncology Research Group were enrolled. The log-rank test and Cox’s proportional hazards model were used to determine the predictive factors for prognosis; rate of castration-resistant prostate cancer (CRPC) and overall survival.

Results

The median age, follow-up period and PSA level at diagnosis were 73 years, 47 months and 174 ng/mL, respectively. The 5-year overall survival rate was 63.0%. The multivariable analysis showed that Gleason score (Hazard ratio [HR]:1.362; 95% confidence interval [C.I.], 1.023-1.813), nadir PSA (HR:6.332; 95% C.I., 4.006-9.861) and time from PADT to nadir (HR:4.408; 95% C.I., 3.099-6.271) were independent prognostic factors of the incidence of CRPC. The independent parameters in the multivariate analysis that predicted overall survival were nadir PSA (HR:5.221; 95% C.I., 2.757-9.889) and time from PADT to nadir (HR:4.008; 95% C.I., 2.137-7.517).

Conclusions

Nadir PSA and time from PADT to nadir were factors that affect both CRPC and overall survival in a cohort of patients with metastatic prostate cancer. Lower nadir PSA level and longer time from PADT to nadir were good for survival and progression.

Keywords:
Prostate cancer; Metastasis; Risk factors