Prognostic significance of changes in prostate-specific markers after endocrine treatment of stage D2 prostatic cancer.
BACKGROUND
The prognostic value was determined of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) measured before and after endocrine treatment in 57 patients with newly diagnosed Stage D2 prostatic cancer.


METHODS
Therapy included orchiectomy or administration of luteinizing hormone releasing hormone analogues or an antiandrogen.


RESULTS
The absolute pretreatment PSA (elevated in 100% of patients) but not PAP (abnormal in 93%) predicted disease progression (P < 0.0011), i.e., a poor response to therapy. Fifty-three patients responded to androgen deprivation with a decrease in PSA level. This declined to normal at 3 and 6 months in 25% of patients. Forty-nine percent had a greater than 90% decrease in their PSA level. By 1 year, 58% of patients had progressive disease. Both the nadir PSA level and the percent decline from the pretreatment level at 3 and 6 months predicted the progression-free interval (P < 0.001). Patients with a 90% or greater decline in PSA had a prolonged progression-free survival. Serial PAP levels were similarly prognostic.


CONCLUSIONS
It was concluded that PSA was better than PAP in evaluating patients before and after androgen-deprivation therapy. The nadir level of both markers was an important tool to predict progression-free survival in patients with metastatic prostatic cancer.
Matzkin
H
H
Department of Urology, University of Miami School of Medicine, Florida 33101.
Eber
P
P
Todd
B
B
van der Zwaag
R
R
Soloway
M S
MS
D000135:Acid Phosphatase / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D005500:Follow-Up Studies; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D011379:Prognosis; D011467:Prostate / Q000201:enzymology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D012074:Remission Induction; D013997:Time Factors
D000726:Androgen Antagonists; D014408:Biomarkers, Tumor; D017273:Goserelin; D000135:Acid Phosphatase; D017430:Prostate-Specific Antigen; D016729:Leuprolide