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Predictors of poor response to first-generation anti-androgens as criteria for alternate treatments for patients with non-metastatic castration-resistant prostate cancer.

Abstract

PURPOSE

There are no criteria for administering first- or second-generation anti-androgens (FGA and SGA, respectively) to patients with non-metastatic castration-resistant prostate cancer (nmCRPC). This study aimed to assess the efficacy of alternative FGA therapy in nmCRPC patients and the prognosis of these patients and to identify factors for predicting patients potentially responsive to FGA.

METHODS

Data from 63 men with nmCRPC who underwent alternative FGA therapy (bicalutamide, flutamide, or chlormadinone acetate) as first-line therapy after failure of primary androgen-deprivation therapy (PADT) between 2004 and 2017 at Hiroshima University Hospital and affiliated hospitals were retrospectively investigated. The associations of clinicopathological parameters with overall survival (OS) and prostate-specific antigen (PSA) progression-free survival (PFS) of alternative FGA-treated patients were analyzed.

RESULTS

Time to CRPC [p = 0.007, hazard ratio (HR) = 4.77], regional lymph node involvement at the diagnosis of CRPC (p = 0.022, HR = 2.42), and PSA-PFS of alternative FGA therapy ≤ 6 months (p = 0.020, HR = 2.39) were identified as prognostic factors using a multivariate analysis. Additionally, Cox proportional hazard models revealed that PSA nadir value > 1 ng/mL during PADT (p = 0.034, HR = 2.40) and time from starting PADT to PSA nadir ≤ 1 year (p = 0.047, HR = 1.85) were predictive factors for worse PSA-PFS in alternative FGA therapy.

CONCLUSIONS

Shorter time to CRPC, regional lymph node involvement, PSA nadir during PADT > 1 ng/mL, and time from starting PADT to PSA nadir ≤ 1 year might suggest the potential benefit of immediate commencement of SGA, compared to FGA administration after nmCRPC diagnosis.

Authors+Show Affiliations

Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan. Department of Urology, Nakatsu Daiichi Hospital, 252-2 Miyabu, Nakatsu, Oita, 871-0012, Japan.Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan. teishima@hiroshima-u.ac.jp.Department of Urology, Nakatsu Daiichi Hospital, 252-2 Miyabu, Nakatsu, Oita, 871-0012, Japan.Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.Department of Urology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asakita-ku, Hiroshima, Hiroshima, 731-0293, Japan.Department of Urology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure, Hiroshima, 737-0023, Japan.Department of Urology, Chugoku Rosai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan.Department of Urology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, Hiroshima, 734-8530, Japan.Department of Urology, JA Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan.Department of Urology, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama, Ehime, 790-8524, Japan.Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31552574

Citation

Fukuoka, Kenichiro, et al. "Predictors of Poor Response to First-generation Anti-androgens as Criteria for Alternate Treatments for Patients With Non-metastatic Castration-resistant Prostate Cancer." International Urology and Nephrology, 2019.
Fukuoka K, Teishima J, Nagamatsu H, et al. Predictors of poor response to first-generation anti-androgens as criteria for alternate treatments for patients with non-metastatic castration-resistant prostate cancer. Int Urol Nephrol. 2019.
Fukuoka, K., Teishima, J., Nagamatsu, H., Inoue, S., Hayashi, T., Mita, K., ... Matsubara, A. (2019). Predictors of poor response to first-generation anti-androgens as criteria for alternate treatments for patients with non-metastatic castration-resistant prostate cancer. International Urology and Nephrology, doi:10.1007/s11255-019-02281-4.
Fukuoka K, et al. Predictors of Poor Response to First-generation Anti-androgens as Criteria for Alternate Treatments for Patients With Non-metastatic Castration-resistant Prostate Cancer. Int Urol Nephrol. 2019 Sep 24; PubMed PMID: 31552574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of poor response to first-generation anti-androgens as criteria for alternate treatments for patients with non-metastatic castration-resistant prostate cancer. AU - Fukuoka,Kenichiro, AU - Teishima,Jun, AU - Nagamatsu,Hirotaka, AU - Inoue,Shogo, AU - Hayashi,Tetsutaro, AU - Mita,Koji, AU - Shigeta,Masanobu, AU - Kobayashi,Kanao, AU - Kajiwara,Mitsuru, AU - Kadonishi,Yuichi, AU - Tacho,Takatoshi, AU - Matsubara,Akio, Y1 - 2019/09/24/ PY - 2019/06/21/received PY - 2019/09/10/accepted PY - 2019/9/26/entrez PY - 2019/9/26/pubmed PY - 2019/9/26/medline KW - Alternative first-generation anti-androgen therapy KW - Non-metastatic castration-resistant prostate cancer KW - PSA nadir KW - Prognostic factors KW - Time to nadir JF - International urology and nephrology JO - Int Urol Nephrol N2 - PURPOSE: There are no criteria for administering first- or second-generation anti-androgens (FGA and SGA, respectively) to patients with non-metastatic castration-resistant prostate cancer (nmCRPC). This study aimed to assess the efficacy of alternative FGA therapy in nmCRPC patients and the prognosis of these patients and to identify factors for predicting patients potentially responsive to FGA. METHODS: Data from 63 men with nmCRPC who underwent alternative FGA therapy (bicalutamide, flutamide, or chlormadinone acetate) as first-line therapy after failure of primary androgen-deprivation therapy (PADT) between 2004 and 2017 at Hiroshima University Hospital and affiliated hospitals were retrospectively investigated. The associations of clinicopathological parameters with overall survival (OS) and prostate-specific antigen (PSA) progression-free survival (PFS) of alternative FGA-treated patients were analyzed. RESULTS: Time to CRPC [p = 0.007, hazard ratio (HR) = 4.77], regional lymph node involvement at the diagnosis of CRPC (p = 0.022, HR = 2.42), and PSA-PFS of alternative FGA therapy ≤ 6 months (p = 0.020, HR = 2.39) were identified as prognostic factors using a multivariate analysis. Additionally, Cox proportional hazard models revealed that PSA nadir value > 1 ng/mL during PADT (p = 0.034, HR = 2.40) and time from starting PADT to PSA nadir ≤ 1 year (p = 0.047, HR = 1.85) were predictive factors for worse PSA-PFS in alternative FGA therapy. CONCLUSIONS: Shorter time to CRPC, regional lymph node involvement, PSA nadir during PADT > 1 ng/mL, and time from starting PADT to PSA nadir ≤ 1 year might suggest the potential benefit of immediate commencement of SGA, compared to FGA administration after nmCRPC diagnosis. SN - 1573-2584 UR - https://www.unboundmedicine.com/medline/citation/31552574/Predictors_of_poor_response_to_first-generation_anti-androgens_as_criteria_for_alternate_treatments_for_patients_with_non-metastatic_castration-resistant_prostate_cancer L2 - https://doi.org/10.1007/s11255-019-02281-4 DB - PRIME DP - Unbound Medicine ER -