Clinical predictors of androgen-independent prostate cancer and survival in the prostate-specific antigen era.
OBJECTIVE
To further characterize and identify novel predictors of androgen-independent prostate cancer (AIPC) and survival in the prostate-specific antigen (PSA) era.


METHODS
A total of 184 consecutive patients with prostate cancer receiving chronic androgen suppression were assessed for the development of AIPC and overall survival.


RESULTS
The median time to development of AIPC was 44 months (Stage M+ = 24 months; Stage M0 = 63 months, P = 0.000001). The 10-year overall survival rate for Stage M0 or M+ disease was 89% and 55%, respectively. AIPC developed significantly more commonly in patients with a higher nadir PSA level (greater than 1 ng/dL), a longer time to reach nadir PSA (greater than 3 months), a larger body mass index (greater than 27 kg/m2), greater pretherapy PSA level, and when evidence of metastatic disease was identified (logistic regression analysis). Overall survival was significantly associated with advanced stage (skeletal metastases), pretreatment PSA level, and history of skeletal fracture (multivariate Cox regression analysis).


CONCLUSIONS
In the PSA era, longer intervals of androgen suppression therapy in nonmetastatic, biochemically recurrent prostate cancer have translated into a change in the duration of androgen-dependent prostate cancer. Although the duration of androgen dependence remains variable, prolonged--possibly "curative"--control exists in a subset of patients. Obese men developed AIPC significantly sooner than did slender men. A skeletal fracture was a significant negative predictor of overall survival. These observations form the basis for nomogram predictions of AIPC in the PSA era.
Oefelein
Michael G
MG
Department of Urology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio 44106 , USA.
Ricchiuti
Vincent S
VS
Conrad
P William
PW
Goldman
Howard
H
Bodner
Donald
D
Resnick
Martin I
MI
Seftel
Allen
A
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D015992:Body Mass Index; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D050723:Fractures, Bone / Q000453:epidemiology; D005598:Fractures, Spontaneous / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen