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Abstract
Background The present study aimed to analyse factors influencing the effects of androgen deprivation therapy (ADT) in patients with newly diagnosed metastatic castration-naïve prostate cancer (mCNPC), especially in low-volume disease (LVD), according to subclassification of metastatic prostate cancer established by the CHAARTED trial. Materials and Methods We reviewed 648 patients with newly diagnosed mCNPC receiving ADT at Chang Gung Memorial Hospital from January 2007 to December 2016. Basic characteristics and PSA kinetics profile were subsequently evaluated. Results 48.3% of LVD patients progressed to castration-resistant prostate cancer (mCRPC). Among them, CRPC group had significantly shorter time to PSA nadir (TTN) and faster time from PSA nadir to CRPC (TFNTC) (p < 0.001) compared to non-CRPC group. PSA doubling time (PSADT) < 4 months tended to be associated with faster disease progression and shorter overall survival (OS). Among all patients with metastatic prostate cancer, those with shorter TTN <9 months, higher nadir PSA level ≥1 ng/mL, and shorter PSADT <3 months had increased tendency for biochemical progression. Conclusions PSADT is an effective clinical predictor for disease progression and survival in LVD. Other PSA kinetics including TTN and TFNTC, though not the major predictors for disease progression or OS in LVD, might be the predictors for disease control status.
Highlights
Prostate cancer is one of the most common malignancies worldwide and the fifth most common cancer in Taiwan, with an age-standardised prostate cancer rate of 31.65 per 100,000 individuals in 2017 and metastatic prostate cancer accounting for nearly 30% of new cases [1,2,3,4]
Patients were grouped into high-volume disease (HVD) and low-volume disease (LVD) according to the CHAARTED trial. is study adhered to the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Chang Gung Medical Foundation (IRB number 201801377B0)
In the study population (Table 1), included patients had a median age of 75 (IQR 68–80) years, with 352 (54.3%) classified as HVD and 296 (45.7%) as LVD according to the CHAARTED trial
Summary
Prostate cancer is one of the most common malignancies worldwide and the fifth most common cancer in Taiwan, with an age-standardised prostate cancer rate of 31.65 per 100,000 individuals in 2017 and metastatic prostate cancer (mPCa) accounting for nearly 30% of new cases [1,2,3,4]. Androgen deprivation therapy (ADT) has been the gold standard for patients with mPCa. after receiving ADT, most of the prostate cancer cells develop drug resistance and progress to castration-resistant prostate cancer (CRPC), necessitating chemotherapy or second-line hormone therapy if feasible. Recent clinical trials and research have shown that upfront chemotherapy plus ADT promoted significantly longer overall survival (OS) in high-volume disease (HVD) [5,6,7,8]. This study showed that patients with HVD receiving a combination of ADT and chemotherapy had a longer median OS (49.2 months) than “Tumor volume,” a new subclassification of metastatic prostate cancer established by the CHAARTED trial, can be classified as “high-volume” (visceral metastases and/or four or more bone metastases with at least one outside the vertebral column and pelvis) or “low-volume.” this study showed that patients with HVD receiving a combination of ADT and chemotherapy had a longer median OS (49.2 months) than
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