Abstract
Simple SummaryProstate cancer is one of the most prevalent cancers in men. Prostate cancer is characterized by an early response to hormonal therapy and prostate-specific antigen (PSA) is useful for diagnosis, prognosis, and treatment evaluation. However, if the patient becomes resistant to treat and develops castration-resistant prostate cancer (CRPC), it is difficult to predict prognosis and evaluate response to treatment using PSA alone. In this study, we found that the high-sensitivity modified Glasgow prognostic score (Hs-mGPS), an inflammatory response score, is a more powerful prognostic factor for CRPC than the modified Glasgow prognostic score (mGPS) previously studied. Furthermore, we suggest that risk classification using Hs-mGPS, PSA, and testosterone (TST) may be a useful tool to predict the prognosis of late staged CRPC.The Glasgow prognostic score, a marker of systemic inflammation, is associated with clinical outcomes in different cancers including prostate cancer. However, there is no evidence for the relationship between the high-sensitivity modified Glasgow prognostic score (Hs-mGPS) in prostate cancer and its prognosis. This study aimed to investigate the prognostic significance of Hs-mGPS in castration-resistant prostate cancer (CRPC) treated with docetaxel. We retrospectively analyzed clinical datasets from 131 CRPC patients who received docetaxel treatment at Chiba University Hospital and a related hospital. Clinical factors including Hs-mGPS before docetaxel treatment were evaluated according to overall survival. The numbers of patients with Hs-mGPS of 0, 1, and 2 were 88, 30, and 13, respectively. The median prostate-specific antigen (PSA) level was 28.9 ng/mL. The median testosterone level was 13.0 ng/dL. The percentages of bone and visceral metastases were 80.8% and 10.2%, respectively. For overall survival, Hs-mGPS ≥ 1 (hazard ratio of 2.41; p = 0.0048), testosterone ≥ 13.0 ng/dL (hazard ratio of 2.23; p = 0.0117), and PSA ≥ 28.9 ng/mL (hazard ratio of 2.36; p = 0.0097) were significant poor prognostic factors in the multivariate analysis. The results of the two-group analysis showed that a higher Hs-mGPS was associated with high PSA, alkaline phosphatase, and testosterone levels. The median testosterone levels for Hs-mGPS of 0, 1, and 2 were 9.0, 16.5, and 23.0, respectively. Based on the multivariate analysis, we created a combined score with three prognostic factors: Hs-mGPS, testosterone, and PSA. The low-risk group (score of 0–1) showed a significantly longer overall survival compared to the intermediate-risk (score of 2–3) and high-risk (score of 4) groups (p < 0.0001). Our results demonstrated that an elevated Hs-mGPS was an independent prognostic factor in CRPC patients treated with docetaxel therapy. Risk classification based on Hs-mGPS, testosterone, and PSA may be useful in predicting the prognosis of CRPC patients.
Highlights
Worldwide, prostate cancer is the second most common cancer in men, with 1.3 million people diagnosed and 360,000 deaths every year according to a 2018 report. [1]
The factors used in the analysis were prostate-specific antigen (PSA), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), testosterone, total protein (TP), total cholesterol (T-CHO), hemoglobin, platelet, and the high-sensitivity modified Glasgow prognostic score (Hs-modified GPS (mGPS))
The univariate analysis showed that bone metastasis (p = 0.0047), PSA (p < 0.0001), alkaline phosphatase (p = 0.0042), testosterone (p = 0.0049), and Hs-mGPS (p = 0.0078) were significant prognostic factors associated with progression-free survival (PFS)
Summary
Prostate cancer is the second most common cancer in men, with 1.3 million people diagnosed and 360,000 deaths every year according to a 2018 report. [1]. Though other novel therapeutic agents, such as androgen receptor axistargeting (ARAT), have been developed [5,6], docetaxel is used as one of the first-line treatments for metastatic hormone-sensitive prostate cancer (mHSPC) with high-volume tumors and metastatic CRPC [7,8,9]. Interleukin (IL)-6 was found to induce the drug resistance of prostate cancer by activating the androgen receptor (AR), and IL-4 was found to be associated with the development of CRPC by regulating coactivators of AR such as The nuclear factor-kappaB (NF-κB) [10,11]. Previous studies have assessed the association between GPS (or mGPS) and survival outcomes in patients with prostate cancer [18,19,20]. The aim of the present study was to determine the importance of predicting the prognosis of the Hs-mGPS in CRPC treated with docetaxel
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