Efficacy And Prognosis Analysis Of Different Combination Therapy Regimens In High-volume Disease Metastatic Hormone-sensitive Prostate Cancer

Objective: Exploring the differences in the efficacy of different combination treatment regimens in high-volume disease metastatic hormone sensitive prostate cancer(m HSPC)and the factors influencing the development of early PSA progression in high-volume disease m HSPCMethod: The clinical data of high-volume disease m HSPC attending Sichuan Academy of Medical Sciences-Sichuan Provincial People’s Hospital from January 2015 to December 2019 were retrospectively analyzed and divided into androgen deprivation therapy(ADT)combined with bicalutamide group(bicalutamide group),ADT combined with docetaxel group(docetaxel group)and ADT combined with abiraterone acetate group(abiraterone group)according to the treatment regimen.The baseline data of the three groups were collected and analyzed,and Kaplan-Meier survival analysis,ANOVA and chi-square test were applied to compare the differences in the primary and secondary efficacy indexes of the three combined treatment regimens.Cox single-factor and multi-factor statistical methods were used to analyze the factors influencing the occurrence of PSA progression in high-volume disease m HSPC,while survival curves were plotted according to Cox multi-factor analysis to further compare the differences in the efficacy of the three groups of patients.Result: A total of 134 cases were included in this study,including 71 cases in the bicalutamide group,34 cases in the docetaxel group,and 29 cases in the abiraterone group.The differences in the distribution of baseline data among the three groups were basically not statistically significant(P>0.05),the baseline data of patients in the different treatment regimen groups were basically balanced and comparable.The median PSA progression-free time(PSA-PFS)was prolonged by 8.9 months in the docetaxel group compared with the bicalutamide group(21.1 vs.12.2 months,P<0.001),by 13.6 months in the abiraterone group compared with the bicalutamide group(25.8 vs.12.2months,P<0.001),and by 4.7 months in the abiraterone group compared with the docetaxel group,with absolute value difference,but no statistical difference(25.8 months vs.21.1 months,P=0.91).The mean PSA minimum was highest in the docetaxel group(4.72 ng/ml),followed by the abiraterone group(1.44ng/ml)and lowest in the bicalutamide group(0.8 ng/ml),with no statistically significant difference between the three groups.The median time to reach PSA nadir(TTN)was 9.13 months in the docetaxel group and 8.83 months in the abiraterone group,both significantly longer than the bicalutamide group at 4.40 months,with statistically significant differences.The incidence of grade 3-4adverse reactions was highest in the docetaxel group(29.41%),followed by the abiraterone group(17.24%)and lowest in the bicalutamide treatment group(12.68%),but there was no statistically significant difference between the three groups.Cox multifactorial analysis identified hypertension,Gleason score ≥8,tumor N stage,PSA nadir <0.2ng/ml,and TTN >5.6 months as factors influencing patient prognosis.Cox multifactorial analysis found longer PSA-PFS in the abiraterone group than in the bicalutamide group(HR=0.413,P=0.01),longer PSA-PFS in the docetaxel group than in the ADT combined bicalutamide group(HR=0.437,P=0.014),and the difference in PSA-PFS between the abiraterone acetate and docetaxel groups was not significant(HR=1.059,P=0.856).Conclusion: ADT combined with docetaxel or ADT combined with abiraterone acetate significantly prolonged PSA-PFS in patients with high-volume disease m HSPC compared with ADT combined with bicalutamide,and although there was no statistical difference in PSA-PFS in the ADT combined with abiraterone acetate group compared with the ADT combined with docetaxel group,the absolute value was prolonged by 4.7 months,and the occurrence of drug-related adverse reactions than ADT combined with docetaxel.Gleason score ≥8 and tumor with regional lymph node metastasis were risk factors for PSA progression in early stage of high-volume disease m HSPC,while PSA nadir<0.2 ng/ml and TTN >5.6 months were protective factors for PSA progression in early stage of high-volume disease m HSPC.