World Cancer Research Journal (Nov 2024)
Prognostic value of prostate-specific antigen in advanced prostate cancer treated with androgen deprivation therapy and abiraterone
Abstract
OBJECTIVE: Prostate-specific antigen (PSA) has been a cornerstone in diagnosing and monitoring prostate cancer. With the advent of advanced hormonal therapies, such as the combination of androgen deprivation therapy (ADT) and abiraterone acetate plus prednisone (AAP+ADT), understanding PSA's prognostic value in metastatic castration-sensitive prostate cancer (mCSPC) is crucial for optimizing treatment strategies. This study was designed to explore the prognostic value of prostate-specific antigen in advanced prostate cancer treated with AAP+ADT. PATIENTS AND METHODS: This study is a prospective, randomized controlled trial (RCT) comparing the effectiveness of ADT alone vs. AAP+ADT in 236 patients with mCSPC. Participants were randomly assigned to one of the two treatment groups, focusing on evaluating PSA progression-free survival and overall survival. The Kaplan-Meier survival curves and Log-rank tests were used for survival comparisons, and the analysis included both univariate and multivariate Cox regression to identify prognostic factors. RESULTS: In this RCT study, a total of 236 mCSPC patients were enrolled and 118 patients received AAP+ADT, while the other 118 patients were treated with ADT alone. Our findings revealed that treatment with AAP+ADT emerged as an independent predictor of favorable PSA trajectory (Hazard Ratio [HR]=0.412, 95% Confidence Interval [CI]: 0.288-0.535, p<0.001), especially pronounced in patients achieving a 50-90% reduction in PSA levels (HR=0.434, 95% CI: 0.173-0.625, p<0.001) and those in the PSA90 reduction category (HR=0.183, 95% CI: 0.103-0.363, p<0.001). CONCLUSIONS: The degree of PSA reduction following AAP+ADT therapy was a robust independent prognostic marker for patients with mCSPC.
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