Original Paper

Prediction of Response to Androgen Deprivation Therapy and Castration Resistance in Primary Metastatic Prostate Cancer
Rauf Taner Divrik^a, Levent Türkeri^b, Ali F. Şahin^c, Bülent Akdoğan^d, Ferhat Ateş^e, Çağ Çal^f, Sümer Baltacı^g, and Members of the Urooncology Association

Departments of Urology,
^aM.H. Tepecik Research and Training Hospital, Izmir,
^bMarmara University, Istanbul,
^cSivas Numune State Hospital, Sivas,
^dHacettep University, Ankara,
^eGATA Haydarpaşa Medical School, Istanbul,
^fEge University, Izmir, and
^gAnkara University, Ankara, Turkey

Address of Corresponding Author

Urol Int 2012;88:25-33 (DOI: 10.1159/000334539)

  Key Words

• Prostate cancer
• Bone metastasis
• Androgen deprivation therapy
• Duration of response
• Nadir PSA
• Time to nadir PSA
• Castration resistance

  Abstract

Purpose: We tried to establish the predictive factors influencing the initial response, as well as its duration, and time to castration resistance (CR) for primary advanced prostate cancer (PC) with bone metastasis. Methods: We evaluated all patients initially receiving androgen deprivation therapy (ADT) for primary advanced PC with bone metastasis. A total of 982 patients with complete medical records available for analysis from 18 centers were included in this study. Age, initial PSA, Gleason score (GS) and extent of bone involvement (EBI) were recorded in a database. Results: Among all the patients, 896 (91.2%) responded to ADT initially. Pretreatment PSA and EBI were significant predictors in the multivariate model. Among the 659 patients who progressed into a CR state, the mean duration of response was 22.4 months. There was a significant correlation between the CR state and nadir PSA (nPSA) level and time to nPSA. Pretreatment PSA, EBI, GS, highest tumor volume in biopsy cores (%), number of positive biopsy cores, percent positive biopsy cores and time to nPSA were proven to be significant to predict a nPSA. Pretreatment PSA, GS and EBI were statistically significant predictors of PSA normalization in multivariate analysis. The limitation of the study depends on the retrospective design and a model was developed for low standardization as a result of using multicenter data. The patients enrolled in this study were from a relatively long period of time (1989–2008). Conclusions: The results of this study indicate that it is possible to predict the initial response to ADT by pretreatment PSA levels and EBI, while the duration of response can be reflected by a multitude of clinical factors including nPSA, TTnPSA, percent positive cores, biopsy GS and EBI.

Copyright © 2011 S. Karger AG, Basel

  Author Contacts

Assoc. Prof. Rauf Taner Divrik, MD
Department of Urology, S.B. Tepecik Eğitim ve Araştırma Hastanesi
Üroloji Kliniği, A Blok 3.Kat, Gaziler cad. No:468 Yenişehir
TR–35120 Izmir (Turkey)
Tel. +90 232 469 6969, E-Mail t.divrik@gmail.com

  Article Information

The members of the Urolooncology Association are: Aydın Mungan, Department of Urology, Karaelmas University; Erem Kaan Başok, Department of Urology, Göztepe Education and Research Hospital; Talha Müezzinoğlu, Department of Urology, Celal Bayar University; Güven Aslan, Department of Urology, Dokuz Eylül University; Bülent Günlüsoy, Department of Urology, İzmir Education and Research Hospital; Mustafa Sofikerim, Department of Urology, Erciyes University; Feridun Şengör, Department of Urology, Haydarpaşa Numune Education and Research Hospital; Ahmet Bölükbaşı, Department of Urology, İzmir Atatürk Education and Research Hospital; Recep Büyükalpelli, Department of Urology, 19 Mayıs University; Murat Bozlu, Department of Urology, Mersin University; Hayrettin Şahin, Department of Urology, Muğla University; Cem Güler, Department of Urology, Balıkesir University.

Received: March 17, 2011
Accepted after revision: October 19, 2011
Published online: December 17, 2011
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 9, Number of References : 14