You have accessJournal of UrologyProstate Cancer: Markers1 Apr 20112292 PSA NADIR DURING ANDROGEN DEPRIVATION THERAPY PREDICTS ADVERSE PROSTATE CANCER SPECIFIC OUTCOMES: RESULTS FROM THE SEARCH DATABASE Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher L. Amling, Christopher J. Kane, and Stephen J. Freedland Christopher J. KetoChristopher J. Keto Durham, NC More articles by this author , William J. AronsonWilliam J. Aronson Los Angeles, CA More articles by this author , Martha K. TerrisMartha K. Terris Augusta, GA More articles by this author , Joseph C. PrestiJoseph C. Presti Palo Alto, CA More articles by this author , Christopher L. AmlingChristopher L. Amling Portland, OR More articles by this author , Christopher J. KaneChristopher J. Kane San Diego, CA More articles by this author , and Stephen J. FreedlandStephen J. Freedland Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2537AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally, a PSA nadir on androgen deprivation therapy (ADT) >4 ng/ml has been correlated with poor outcome. More recently, a PSA nadir >0.2 ng/ml has been associated with prostate cancer (PC) specific mortality (PCSM). However, whether all men with nadir values <0.2 ng/ml have similar outcomes is untested. We examined the predictive value of PSA nadir including small but detectable nadir values during ADT on PC specific outcomes in men treated with early ADT for PSA-only recurrence after radical prostatectomy (RP) within the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. METHODS We retrospectively reviewed data from 2892 men treated with RP between 1988 and 2010 within the SEARCH database to identify men treated with early ADT, defined as no evidence of metastatic disease at the start of ADT. PSA nadir on ADT was defined as the lowest PSA value during continuous ADT. PSA nadir was analyzed as a continuous variable and was also categorized to three groups: 0, 0.01–0.2, and >0.2ng/mL. Cox proportional hazards models were used to examine the link between PSA nadir and castrate resistant PC (CRPC), metastatic disease, and PCSM with the date of PSA nadir on ADT as time zero. RESULTS During a median follow-up of 73 months after RP, 405 men (14%) were treated with early ADT. Of these men, 322 had complete data for analysis with a median follow-up after ADT nadir of 51 months. When examined as a continuous variable, higher PSA nadir on ADT was associated with progression to CRPC (HR=2.5, p<0.0001), development of metastatic disease (HR=2.1, p=0.001) and PCSM (HR=1.8, p=0.020). Men with a PSA nadir between 0.01–0.2 ng/mL were more likely to progress to CRPC (HR=4.1, p=0.001), develop metastases (HR=3.3, p=0.027) and ultimately die of prostate cancer (HR=4.5, p=0.011) than men with an undetectable nadir. Finally, relative to men with an undetectable nadir, those with a nadir >0.2ng/mL were at the greatest risk of progression to CRPC (HR=29.0, p=0.001), development of metastases (HR=13.1, p<0.001) and PCSM (HR=9.3, p<0.0001). CONCLUSIONS A detectable PSA nadir on ADT of any level is associated with increased risk for CRPC, metastases, and PCSM. Men who do not achieve an undetectable PSA nadir during ADT are at a dramatically increased risk of disease progression and therefore, should be considered for clinical trials. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e919 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher J. Keto Durham, NC More articles by this author William J. Aronson Los Angeles, CA More articles by this author Martha K. Terris Augusta, GA More articles by this author Joseph C. Presti Palo Alto, CA More articles by this author Christopher L. Amling Portland, OR More articles by this author Christopher J. Kane San Diego, CA More articles by this author Stephen J. Freedland Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...