Yonsei Med J.  2015 Mar;56(2):368-374. 10.3349/ymj.2015.56.2.368.

Exponential Rise in Prostate-Specific Antigen (PSA) during Anti-Androgen Withdrawal Predicts PSA Flare after Docetaxel Chemotherapy in Patients with Castration-Resistant Prostate Cancer

• Han KS
• Hong SJ

• KMID: 2070012
• DOI: http://doi.org/10.3349/ymj.2015.56.2.368

Abstract

PURPOSE
To investigate the relationship between rising patterns of prostate-specific antigen (PSA) before chemotherapy and PSA flare during the early phase of chemotherapy in patients with castration-resistant prostate cancer (CRPC).
MATERIALS AND METHODS
This study included 55 patients with CRPC who received chemotherapy and in whom pre-treatment or post-treatment PSA levels could be serially obtained. The baseline parameters included age, performance, Gleason score, PSA level, and disease extent. PSA doubling time was calculated using the different intervals: the conventional interval from the second hormone manipulation following the nadir until anti-androgen withdrawal (PSADT1), the interval from the initial rise after anti-androgen withdrawal to the start of chemotherapy (PSADT2), and the interval from the nadir until the start of chemotherapy (PSADT3). The PSA growth patterns were analyzed using the ratio of PSADT2 to PSADT1.
RESULTS
There were two growth patterns of PSA doubling time: 22 patients (40.0%) had a steady pattern with a more prolonged PSADT2 than PSADT1, while 33 (60.0%) had an accelerating pattern with a shorter PSADT2 than PSADT1. During three cycles of chemotherapy, PSA flare occurred in 11 patients (20.0%); of these patients, 3 were among 33 (9.1%) patients with an accelerating PSA growth pattern and 8 were among 22 patients (36.4%) with a steady PSA growth pattern (p=0.019). Multivariate analysis showed that only PSA growth pattern was an independent predictor of PSA flare (p=0.034).
CONCLUSION
An exponential rise in PSA during anti-androgen withdrawal is a significant predictor for PSA flare during chemotherapy in CRPC patients.

Keyword

Prostate cancer; castration-resistant; prostate-specific antigen; prostate-specific antigen doubling time; prostate-specific antigen flare

MeSH Terms

Aged
Aged, 80 and over
Androgen Antagonists
Antineoplastic Agents/*therapeutic use
Follow-Up Studies
Humans
Karnofsky Performance Status
Male
Middle Aged
Neoplasm Grading
Predictive Value of Tests
Prostate-Specific Antigen/*blood
Prostatic Neoplasms, Castration-Resistant/*blood/*drug therapy/pathology
Taxoids/*therapeutic use
Tumor Markers, Biological/blood
Androgen Antagonists
Antineoplastic Agents
Prostate-Specific Antigen
Taxoids
Tumor Markers, Biological

Figure

• 

  Fig. 1 Schematic graph of PSA doubling times according to different intervals during the transient period from the diagnosis of CRPC until the end of anti-androgen withdrawal and PSA response during docetaxel chemotherapy. PSA, prostate-specific antigen; PSADT1, PSA doubling time calculated with the traditional interval from the first rise greater than the nadir during androgen deprivation therapy until androgen withdrawal; PSADT2, PSA doubling time from the initial rise after anti-androgen withdrawal until the start of chemotherapy; PSADT3, PSA doubling time during the total interval from the nadir until the start of chemotherapy.

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