title: Persistent prostate-specific antigen expression after neoadjuvant androgen depletion: an early predictor of relapse or incomplete androgen suppression.
abstract: OBJECTIVE
  To analyze post-androgen depletion (AD) primary tumors to identify markers of treatment failure because AD does not reduce the probability of prostate-specific antigen (PSA) failure after prostatectomy.
  
  
  METHODS
  Tumors removed by radical prostatectomy after 3 months of AD from 21 patients were analyzed for gene expression using oligonucleotide arrays. Differences between patients with and without relapse were identified using a conservative significance criteria of a threefold change and delta 0.68, ensuring a false discovery rate of less than 11%.
  
  
  RESULTS
  At 50 months of follow-up, 7 of the 18 evaluable patients developed a biochemical recurrence. Gleason grade, pretherapy PSA level, T stage, and margin status were similar between the two groups. Patients with recurrence had greater post-AD PSA levels than those without recurrence (0.87 versus 0.19 ng/mL; P = 0.042). Gene expression analysis revealed 35 probe sets overexpressed in tumors from patients who relapsed. Among the highest ranked probe sets were PSA and other androgen-responsive genes. Serum PSA values during AD revealed similar findings. After 40 days of AD, the PSA level in those without recurrence was 1.21 ng/mL versus 4.5 ng/mL in those with recurrence (P = 0.0034). Immunohistochemistry of post-AD tumors also demonstrated a high PSA staining intensity in many tumors that recurred relative to those that didn't.
  
  
  CONCLUSIONS
  The results of our study show that early recurrence is associated with expression of androgen-responsive genes. Surprisingly, these could be identified as early as 3 months after the initiation of AD therapy. Whether this represents a failure to abrogate androgen receptor mediated signaling with androgen depletion or early reactivation of signaling is under study.
authors.affiliation: Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ryan
authors.forename: Alex
authors.initials: A
authors.lastname: Smith
authors.forename: Priti
authors.initials: P
authors.lastname: Lal
authors.forename: Jaya
authors.initials: J
authors.lastname: Satagopan
authors.forename: Victor
authors.initials: V
authors.lastname: Reuter
authors.forename: Peter
authors.initials: P
authors.lastname: Scardino
authors.forename: William
authors.initials: W
authors.lastname: Gerald
authors.forename: Howard I
authors.initials: HI
authors.lastname: Scher
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics*; D005485:Flutamide / Q000627:therapeutic use; D015870:Gene Expression; D020869:Gene Expression Profiling; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood / Q000235:genetics*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000235:genetics* / Q000628:therapy; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D017273:Goserelin; D005485:Flutamide; D017430:Prostate-Specific Antigen