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Optimal PSA Threshold for Androgen-Deprivation Therapy in Patients with Prostate Cancer following Radical Prostatectomy and Adjuvant Radiation Therapy

 Hyun Kyu Ahn  ;  Kwang Suk Lee  ;  Daeho Kim  ;  Koon Ho Rha  ;  Sung Joon Hong  ;  Byung Ha Chung  ;  Kyo Chul Koo 
 YONSEI MEDICAL JOURNAL, Vol.61(8) : 652-659, 2020-08 
Journal Title
Issue Date
Aged ; Androgen Antagonists / therapeutic use* ; Disease Progression ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local / surgery ; Prognosis ; Proportional Hazards Models ; Prostate-Specific Antigen / metabolism* ; Prostatectomy* ; Prostatic Neoplasms / drug therapy* ; Prostatic Neoplasms / pathology ; Prostatic Neoplasms / radiotherapy ; Prostatic Neoplasms / surgery* ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate ; Treatment Outcome
Androgens ; neoplasm metastasis ; prostatic neoplasm ; survival
Purpose: The benefits of early administration of androgen-deprivation therapy (ADT) in patients with prostate-specific antigen (PSA)-only recurrent prostate cancer (PCa) following radical prostatectomy (RP) are controversial. We investigated the impact of early versus delayed ADT on survival outcomes in patients with non-metastatic, localized or locally advanced PCa who received radiation therapy (RT) following RP and later developed distant metastasis.

Materials and methods: A retrospective analysis was performed on 69 patients with non-metastatic, localized or locally advanced PCa who received RT following RP and later developed distant metastasis between January 2006 and December 2012. Patients were stratified according to the level of PSA at which ADT was administered (<2 ng/mL vs. ≥2 ng/mL). Study endpoints were progression to castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival (CSS).

Results: Patients were stratified according to the criteria of 2 ng/mL of PSA at which ADT was administered, based on the Youden sensitivity analysis. Delayed ADT at PSA ≥2 ng/mL was an independent prognosticator of cancer-specific mortality (p=0.047), and a marginally significant prognosticator of progression to CRPC (p=0.051). During the median follow-up of 81.0 (interquartile range 54.2-115.7) months, patients who received early ADT at PSA <2 ng/mL had significantly higher CSS rates compared to patients who received delayed ADT at PSA ≥2 ng/mL (p=0.002). Progression to CRPC-free survival was comparable between the two groups (p=0.331).

Conclusion: Early ADT at the PSA level of less than 2 ng/mL confers CSS benefits in patients with localized or locally advanced PCa who were previously treated with RP.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koo, Kyo Chul(구교철) ORCID logo https://orcid.org/0000-0001-7303-6256
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Lee, Kwang Suk(이광석) ORCID logo https://orcid.org/0000-0002-7961-8393
Chung, Byung Ha(정병하) ORCID logo https://orcid.org/0000-0001-9817-3660
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
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