Analysis Of Short Term Castration Resistance In Patients With Advanced Metastatic Prostate Cancer

Objective: To investigate related factors in patients of Advanced metastatic Prostate Cancer treated with androgen deprivation therapy which eventually develop to the castration resistant prostate cancer.Methods and materials: We retrospectively investigated the medical records of 216 patients who are treated with androgen deprivation therapy in the First Affiliated Hospital of Fujian Medical University for Advanced metastatic Prostate Cancer between January 2006 and December 2015.The analysis of clinical and radiographic parameters of pre and post-treatment,such as Gleason score,alkaline phosphatase,the baseline value of PSA,Time to PSA nadir,PSA nadir,Lactate dehydrogenase,Hemoglobin,the number of bone metastasis,viscera and bone metastasiswas were dealt with statistics software SPSS 21.0.We analysed the correlation between the clinical and imaging parameters and progression to castration resistant prostate cancer.Cumulative survival plots were made using the Kaplan-Meier method and were compared with the log rank test.Coxregression was used for univariate and multivariate analysis.Log-rank method was used for the significance test.Results:a total of 216 patients with advanced metastatic prostate cancer were enrolled in study.The last follow-up period was February 2017.The median follow-up time was 14.00 months(3.00-88.00 months).The patients with progression to castration resistant prostate cancer were 143(66.2%),while no progression were 73 cases(33.8%).On Cox univariate analysis,the baseline value of PSA,Gleason score,alkaline phosphatase,PSA nadir,Timeto PSA nadir,thenumberof bonemetastasis,limbbone metastasis,visceralmetastasiswere significantly differed(P<0.05)onadvanced metastatic prostate cancer progression to castration resistant prostate cancer.On multiple logistic regression analysis,Gleason score(HR,2.145;95%CI,1.240-3.710;P=0.006),PSA nadir(HR,2.828;95%CI,1.630-4.905;P<0.001),Time to PSA nadir(HR,0.200;95%CI,0.122-0.327;P<0.001)were independent predictor of advanced metastatic prostate cancer progression to castration resistant prostate cancer.Kaplan-Meier survival curves showed that the Gleason score>7 points,PSA nadir>0.2ng/ml,TTPN<6 months were compared with Gleason score≤7 points,PSA nadir≤0.2ng/ml,TTPN≥6months in patients with a shorter progression free survival time(Log-rank P<0.001).Conclusion: The Gleason score,PSA nadir and Time to PSA nadir were independent predictor of advanced metastatic prostate cancer progression to castration resistant prostate cancer.The higher Gleason score,shorter time to PSA nadir,higher PSA nadir were significant predictive factors of advanced metastatic prostate cancer progression to castration resistant prostate cancer.It can help clinician recognize patients who are prone to CRPC,which can provide such high-risk patients with chemotherapy,abiraterone and other interventions,so as to improve the quality of life and prolong the survival time of patients.