PSA Kinetics as Prognostic Markers of Overall Survival in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Abiraterone Acetate

Sofia España; Maria Ochoa de Olza; Nuria Sala; Josep Maria Piulats; Ulises Ferrandiz; Olatz Etxaniz; Lucia Heras; Oscar Buisan; Juan Carlos Pardo; Jose F Suarez; Pilar Barretina; Josep Comet; Xavier Garcia Del Muro; Lauro Sumoy; Albert Font

doi:10.2147/CMAR.S270392

PSA Kinetics as Prognostic Markers of Overall Survival in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Abiraterone Acetate

Cancer Manag Res. 2020 Oct 16:12:10251-10260. doi: 10.2147/CMAR.S270392. eCollection 2020.

Authors

Affiliations

¹ Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain.
² Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain.
³ Catalan Institute of Oncology, Medical Oncology Department, University Hospital Josep Trueta, Girona, Spain.
⁴ Medical Oncology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain.
⁵ Urology Department, University Hospital Germans Trias I Pujol, Badalona, Spain.
⁶ Urology Department, Bellvitge University Hospital, Hospitalet de LLobregat, Spain.
⁷ Urology Department, University Hospital Josep Trueta, Girona, Spain.
⁸ High Content Genomics & Bioinformatics Unit, Germans Trias I Pujol Research Institute (IGTP), Program of Predictive and Personalized Medicine of Cancer (PMPPC), Campus Can Ruti, Badalona, Spain.

Abstract

Background: Abiraterone acetate (AA) is widely used in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC). However, a significant percentage of patients will still progress, highlighting the need to identify patients more likely to benefit from AA. Parameters linked to prostate-specific antigen (PSA) kinetics are promising prognostic markers. We have examined clinical and PSA-related factors potentially associated with overall survival (OS) in patients treated with AA.

Methods: Between 2011 and 2014, 104 patients with mCRPC treated with AA after progression to docetaxel at centers of the Catalan Institute of Oncology were included in this retrospective study. Patients were assessed monthly. Baseline characteristics and variables related to PSA kinetics were included in univariate and multivariate analyses of OS.

Results: Median OS was 16.4 months (range 12.4-20.6) for all patients. The univariate analysis identified the following baseline characteristics as significantly associated with OS: ECOG PS, location of metastases, time between starting androgen deprivation therapy and starting AA, time between stopping docetaxel treatment and starting AA, neutrophil-lymphocyte ratio (NLR), alkaline phosphatase levels, and PSA levels. Factors related to PSA kinetics associated with longer OS were PSA response >50%, early PSA response (>30% decline at four weeks), PSA decline >50% at week 12, PSA nadir <2.4ng/mL, time to PSA nadir >140 days, the combination of PSA nadir and time to PSA nadir, and low end-of-treatment PSA levels. The multivariate analysis identified ECOG PS (HR 37.46; p<0.001), NLR (HR 3.7; p<0.001), early PSA response (HR 1.22; p=0.002), and time to PSA nadir (HR 0.39; p=0.002) as independent prognostic markers.

Conclusion: Our results indicate an association between PSA kinetics, especially early PSA response, and outcome to AA after progression to docetaxel. Taken together with other factors, lack of an early PSA response could identify patients who are unlikely to benefit from AA and who could be closely monitored with a view to offering alternative therapies.

Keywords: PSA kinetics; abiraterone; castration-resistant prostate cancer; early PSA response; survival.

Grants and funding

This study received no outside funding.