Natural History of Rising Serum Prostate-Specific Antigen in Men With Castrate Nonmetastatic Prostate Cancer
- 1 May 2005
- journal article
- clinical trial
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 23 (13), 2918-2925
- https://doi.org/10.1200/jco.2005.01.529
Abstract
To describe the natural history of nonmetastatic prostate cancer and rising prostate-specific antigen (PSA) despite androgen deprivation therapy. The 201 patients in this report were the placebo control group from an aborted randomized controlled trial to evaluate the effects of zoledronic acid on time to first bone metastasis in men with prostate cancer, no bone metastases, and rising PSA despite androgen deprivation therapy. Relationships between baseline covariates and clinical outcomes were assessed by Cox proportional hazard analyses. Covariates in the model were baseline PSA, Gleason sum, history of bilateral orchiectomies, regional lymph node metastases at diagnosis, prior prostatectomy, time from androgen deprivation therapy to random assignment, time from diagnosis to random assignment, and PSA velocity. At 2 years, 33% of patients had developed bone metastases. Median bone metastasis-free survival was 30 months. Median time to first bone metastases and overall survival were not reached. Baseline PSA level greater than 10 ng/mL (relative risk, 3.18; 95% CI, 1.74 to 5.80; P < .001) and PSA velocity (4.34 for each 0.01 increase in PSA velocity; 95% CI, 2.30 to 8.21; P < .001) independently predicted shorter time to first bone metastasis. Baseline PSA and PSA velocity also independently predicted overall survival and metastasis-free survival. Other covariates did not consistently predict clinical outcomes. Men with nonmetastatic prostate cancer and rising PSA despite androgen deprivation therapy have a relatively indolent natural history. Baseline PSA and PSA velocity independently predict time to first bone metastasis and survival.This publication has 17 references indexed in Scilit:
- Docetaxel and Estramustine Compared with Mitoxantrone and Prednisone for Advanced Refractory Prostate CancerThe New England Journal of Medicine, 2004
- Docetaxel plus Prednisone or Mitoxantrone plus Prednisone for Advanced Prostate CancerThe New England Journal of Medicine, 2004
- Cancer Statistics, 2004CA: A Cancer Journal for Clinicians, 2004
- The Statistical Analysis of Failure Time DataWiley Series in Probability and Statistics, 2002
- PSA Doubling Time as a Predictor of Clinical Progression After Biochemical Failure Following Radical Prostatectomy for Prostate CancerMayo Clinic Proceedings, 2001
- Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate CancerThe New England Journal of Medicine, 1999
- Natural History of Progression After PSA Elevation Following Radical ProstatectomyJama-Journal Of The American Medical Association, 1999
- RECURRENCE PATTERNS AFTER RADICAL RETROPUBIC PROSTATECTOMY: CLINICAL USEFULNESS OF PROSTATE SPECIFIC ANTIGEN DOUBLING TIMES AND LOG SLOPE PROSTATE SPECIFIC ANTIGENJournal of Urology, 1997
- Improved Survival in Patients with Locally Advanced Prostate Cancer Treated with Radiotherapy and GoserelinThe New England Journal of Medicine, 1997
- Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council trialBritish Journal of Urology, 1997