Natural History of Rising Serum Prostate-Specific Antigen in Men With Castrate Nonmetastatic Prostate Cancer

• Published in: Journal of clinical oncology Vol. 23; no. 13; pp. 2918 - 2925
• Main Authors: SMITH, Matthew R, KABBINAVAR, Fairooz, LINNARTZ, Ronald, MING ZHENG, GOESSL, Carsten, HEI, Yong-Jiang, SMALL, Eric J, COOK, Richard, HIGANO, Celestia S, SAAD, Fred, ARIFHUSSAIN, GITTELMAN, Marc C, BILHARTZ, David L, WYNNE, Chris, MURRAY, Robin, ZINNER, Norman R, SCHULMAN, Claude
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.05.2005; Lippincott Williams & Wilkins
• Subjects: Aged; Androgen Antagonists - therapeutic use; Biological and medical sciences; Biomarkers, Tumor - analysis; Bone Neoplasms - prevention & control; Bone Neoplasms - secondary; Diphosphonates - therapeutic use; Disease Progression; Double-Blind Method; Follow-Up Studies; Humans; Imidazoles - therapeutic use; Male; Medical sciences; Nephrology. Urinary tract diseases; Placebos; Predictive Value of Tests; Prognosis; Prostate-Specific Antigen - analysis; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Survival Analysis; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Zoledronic Acid; Prostate specific antigen; Human; Urinary system disease; Cancerology; Prostate disease; Adult; Serum; Tumoral marker; Malignant tumor; Male genital diseases; Prostate cancer
• DOI: 10.1200/JCO.2005.01.529
• ISSN: 0732-183X

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.