MP70-03 OPTIMAL TIMING OF HORMONAL THERAPY FOR PROSTATE-SPECIFIC ANTIGEN RECURRENCE AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2014MP70-03 OPTIMAL TIMING OF HORMONAL THERAPY FOR PROSTATE-SPECIFIC ANTIGEN RECURRENCE AFTER RADICAL PROSTATECTOMY Kazuhiro Matsumoto, Ryuichi Mizuno, Nobuyuki Tanaka, Hiroki Ide, Masanori Hasegawa, Masaru Ishida, Nozomi Hayakawa, Yota Yasumizu, Masayuki Hagiwara, Satoshi Hara, Eiji Kikuchi, Akira Miyajima, Ken Nakagawa, Yosuke Nakajima, So Nakamura, Jun Nakashima, and Mototsugu Oya Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Ryuichi MizunoRyuichi Mizuno More articles by this author , Nobuyuki TanakaNobuyuki Tanaka More articles by this author , Hiroki IdeHiroki Ide More articles by this author , Masanori HasegawaMasanori Hasegawa More articles by this author , Masaru IshidaMasaru Ishida More articles by this author , Nozomi HayakawaNozomi Hayakawa More articles by this author , Yota YasumizuYota Yasumizu More articles by this author , Masayuki HagiwaraMasayuki Hagiwara More articles by this author , Satoshi HaraSatoshi Hara More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , Ken NakagawaKen Nakagawa More articles by this author , Yosuke NakajimaYosuke Nakajima More articles by this author , So NakamuraSo Nakamura More articles by this author , Jun NakashimaJun Nakashima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2202AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The routine use of prostate-specific antigen (PSA) monitoring after radical prostatectomy (RP) has frequently identified men with biochemical disease recurrence (BCR). However, the appropriate timing and type of therapy for them remain controversial. The present study was undertaken to examine biochemical progression in patients who received salvage hormonal therapy (HT) for BCR after RP, and to determine the optimal timing for the administration of HT. METHODS The study population consisted of 156 patients who underwent RP during the period of 1991-2007 and received HT for BCR. The starting point was the timing of RP, and the endpoint was biochemical progression (castration-resistance) after the combined androgen blockade HT. The mean follow-up period was 8.1 years. RESULTS First, we excluded 18 patients with persistent PSA (≥0.2 ng/mL) after RP from an analysis below to remove any bias due to the inhomogeneous backgrounds because their prognoses were significantly poorer compared with 138 patients whose PSA nadirs had reached <0.2 ng/mL. In the remaining 138 patients, multivariate analysis showed that Gleason score ≥8 (p=0.010, hazard ratio (HR) 3.02), and PSA-doubling time (DT) <6 months (p=0.001, HR 7.39) were independently associated with subsequent biochemical progression after HT. Using these two variables (Gleason score and PSA-DT), we defined patients with both risk factors as ′high-risk′ for biochemical progression. Next, to determine the optimal timing for HT administration, we divided the patients according to the PSA level at the initiation of HT. In the 27 high-risk patients with both risk factors, the PSA cutpoint of 1.0 ng/mL at the initiation of HT showed a significant difference in progression-free survival rates (Figure 1a, p=0.023). On the other hand, in the 111 non-high-risk patients, the cutpoint of PSA 4.0 ng/ml demonstrated a significant difference between the two cohorts (Figure 1b, p=0.034). CONCLUSIONS The findings indicated that for high-risk patients (Gleason score ≥8 and PSA-DT <6 months), salvage HT for BCR after PSA nadir (< 0.2 ng/mL) should be started before the PSA level exceeds 1.0 ng/mL, otherwise there is a significant risk of subsequent biochemical progression after HT. Meanwhile, the induction of salvage HT could be delayed in non-high-risk patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e807 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Kazuhiro Matsumoto More articles by this author Ryuichi Mizuno More articles by this author Nobuyuki Tanaka More articles by this author Hiroki Ide More articles by this author Masanori Hasegawa More articles by this author Masaru Ishida More articles by this author Nozomi Hayakawa More articles by this author Yota Yasumizu More articles by this author Masayuki Hagiwara More articles by this author Satoshi Hara More articles by this author Eiji Kikuchi More articles by this author Akira Miyajima More articles by this author Ken Nakagawa More articles by this author Yosuke Nakajima More articles by this author So Nakamura More articles by this author Jun Nakashima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...