Factors Influencing The Progression Free Survival Time Of Prostate Cancer Patients After Androgen Deprivation Therapy

BackgroundProstate cancer is one of the most common male malignancies in the world.Its incidence is in the second place of male malignancies all over the world.In China,the incidence of prostate cancer is in the sixth place,lower than the world’s average incidence.However,from the longitudinal perspective,the incidence of prostate cancer in China showed a rapid and continuous rising trend,with an average annual increase rate of 12.07%in the past 10 years.Prostate cancer is becoming a malignant tumor of urinary system that affects the health of men in China seriously.Due to the lack of screening work in China,most of the patients of prostate cancer are in the late stage when they are diagnosed clinically,and lose the opportunity of surgery.Endocrine therapy is the preferred treatment plan for these patients,but it lacks meaningful clinical indicators to judge the efficacy of endocrine therapy in these patients,and to evaluate the risk of castrated resistance prostatic cancer in these patients.PSA is an important tumor marker of prostate cancer.In patients of prostate cancer who are treated with endocrine therapy,PSA level can be measured to evaluate the efficacy of the treatment.Clinical doctors always focus on the absolute PSA level at each time point but ignore the dynamic changes of PSA in the whole process,which have potential predictive value for disease progression.ObjectiveTo explore the correlation between the clinical pathological characteristics and overall survival,disease specific survival rate,progression of post-endocrine-therapy patients of prostate cancer.To explore the prediction indicator of overall survival,disease specific survival rate,progression of post-endocrine-therapy patients of prostate cancer and to establish a simple prognosis index model to predict the prognosis of prostate cancer.MethodsThe clinical data of 113 prostate cancer patients were collected and analyzed.The correlations of age,bone metastasis,TNM stage,Gleason score,PSA level before treatment,ALP,nadir PSA level and time to PSA nadir following primary androgen deprivation therapy(ADT)were analyzed by COX regression and Kaplan—Meier(KM)analysis.Log-rank test was used to calculate the P values of KM.ResultsKaplan-meier survival analysis and univariate analysis of COX regression showed T stage,N stage,time to PSA nadir were significantly with prostate cancer overall survival(P<0.1).Gleason score,N stage,nadir PSA level and time to PSA nadir after ADT had significant effects on disease-specific survival(P<0.1).bone metastasis,the T stage,M stage,ALP,nadir PSA level and time to PSA nadir after ADT were significantly with prostate cancer progression(P<0.1).Further multivariate analysis was performed,which revealed time to PSA nadir after ADT was an independent predictor of overall survival rate and disease-specific survival rate(P<0.05),while ALP,nadir PSA level and time to PSA nadir after ADT were still significant independent risk factor of prostate cancer progression(P<0.05).After combining nadir PSA level and time to PSA nadir,it suggested that patients with nadir PSA level greater than 0.2ng/ml and time to PSA nadir less than 9 months had significantly worse prognosis than other groups(P<0.001).The prognosis index model for simple prediction of prostate cancer progression was PI=1.451 x ALP+1.183 x nadir PSA level-2.129 x time to PSA nadir,with a sensitivity of 87.80%and a specificity of 66.67%ConclusionThe present study demonstrated that ALP,nadir PSA level and time to PSA nadir are strong predictors in prostate cancer patients with ADT therapy.Time to PSA nadir is an independent predictor of overall and disease-specific survival of prostate cancer.ALP,nadir PSA level and time to PSA nadir after ADT are predictive markers for disease progression in post-endocrine-therapy patients of prostate cancer.After endocrine therapy,patients with nadir PSA level>0.2ng/ml and time to PSA nadir<9 months had significantly more disease progression than other groups,who were high-risk groups of disease progression after endocrine therapy.