Impact of Prostate-Specific Antigen (PSA) Nadir and Time to PSA Nadir on Disease Progression in Prostate Cancer Treated With Androgen-Deprivation Therapy

BACKGROUND. The influence of PSA kinetics on the outcome of metastatic prostate cancer after androgen deprivation therapy (ADT) is not well understood. We evaluated the prognostic significance of PSA nadir and time to PSA nadir as well as their potential interactive effect on the progression of disease after ADT. METHODS. A total of 650 men with advanced or metastatic prostate cancer treated with ADT were studied. The prognostic significance of PSA nadir and time to PSA nadir on disease progression were analyzed using Kaplan-Meier analysis and the Cox regression model. RESULTS. We found that both PSA nadir and time to PSA nadir were independent and significant predictors of disease progression. Patients with higher PSA nadir (>= 0.2 ng/ml) and shorter time to PSA nadir (< 10 months) had significant shorter time to disease progression after adjusting for other covariates. The combined analyses showed a potential synergistic effect of these two variables on disease progression. Patient with higher PSA nadir and shorter time to PSA nadir had significantly higher risk for disease progression compared to those with lower PSA nadir and longer time to PSA nadir (Hazard Ratios (HR) = 3.11, P<0.001). CONCLUSIONS. We concluded that both PSA nadir and time to PSA nadir are significant predictors of disease progression for prostate cancer patients receiving ADT. Prostate 71: 1189-1197, 2011. (C) 2011 Wiley-Liss, Inc.