Clinical and Pathological Prognostic Factors for Prostate Cancer Progression to a Castration Resistant Disease

Abstract

Author(s): Ahmed Abdul Hussein Attyia, Alaadin S. Naji

Prostate Cancers (PC) are one of the few tumors in humans known to be driven by hormones, namely androgens. Androgen Deprivation Therapy (ADT) has long been considered the mainstay management for metastatic PC. Despite initial response to ADT, almost all patient with metastatic prostate cancer will eventually have disease progression marked by a rise in serum PSA level and clinical or radiological evidence of new metastatic lesions, a state termed Castration Resistant Prostate Cancer (CRPC). The aim of the study to study the clinical and pathological factors associated with shorter Progression Free Survival (PFS) in cases maintained on ADT. A retrospective cross-sectional study of 100 patients with metastatic prostate cancer receiving ADT. Patient data were collected at the time of start of ADT and PFS was calculated from the start of ADT until disease progression either biochemical (rising PSA) or clinical/ radiological. Studied variables include age, PSA at the start of ADT, time to PSA nadir after start of ADT, Gleason score and metastatic sites. Mean age of the patients was 72.5 ± 10.3 years, mean Gleason score was 7.6 ± 1.2, 80% of patients had PSA > 20, 83% of patients had bone only metastasis and 93% of patients had negative history for use of ADT in the adjuvant setting. The mean progression free survival in the study cohort was 14.5 ± 10.7 months. Pearson correlation test shown that there was a strong negative correlation between Gleason score and PFS (r=-0.62, p<0.001), and time to PSA nadir after start of ADT and PFS (r=-0.3, p=0.003), while there was no correlation between baseline PSA before treatment and progression free survival (p=0.17). The mean PFS shown no significant difference with different age groups (p=0.13), and previous use of ADT (p=0.71), while the mean PFS was significantly higher in patients with only bone secondaries (p=0.002) compared with patients with visceral metastasis. This study demonstrated that higher Gleason grade, longer time to PSA nadir after start of ADT, and, visceral metastasis is associated with shorter time of progression to CRPC. Age, baseline PSA level before start of ADT, and, previous use of ADT in the adjuvant setting does not seem to influence the risk of the progression to CRPC.

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