title: Outcome of patients with hormone-refractory prostate cancer: prognostic significance of prostate-specific antigen-doubling time and nadir prostate-specific antigen.
abstract: OBJECTIVE
  Most patients with advanced prostate cancer after prostate-specific antigen (PSA) relapse following maximum androgen blockade rapidly progress to death. The present study was aimed to predict the survival of these serious patients after PSA relapse.
  
  
  METHODS
  Sixty-eight patients with M1b and 20 patients with T3b, who relapsed and died of cancer within a short period, were studied. PSA-doubling time (PSA-DT) at PSA relapse influenced the outcome after PSA relapse [hazard ratio (CI): 2.000 (1.283-3.226)]; thus, on the basis of the median values of PSA-DT (>2 months) and additionally nadir PSA in previous treatment (</=2 ng/ml), patients were stratified into four groups. Outcome in the respective groups was examined.
  
  
  RESULTS
  The patients with PSA-DT of >2 months and nadir PSA of </=2 ng/ml showed the longest survival. The other patients in various classifications proceeded with the similarly worse outcomes, in which PSA-DT still influenced survival [hazard ratio (CI): 0.422 (0.203-0.878)]. In several treatments, estramustine phosphate and dexamethasone were relatively effective. A similar rate of response to these drugs was obtained in all four groups, irrespective of stratifying with PSA-DT and nadir PSA, and this may be possibly due to the intervals between relapse and treatments, in which tumor volume was increased and tumor property was altered. Patients responding to treatment showed prolonged survival.
  
  
  CONCLUSIONS
  Both PSA-DT and nadir PSA were predictive factors for subsequent survival at PSA relapse, and the patients with long PSA-DT and low nadir PSA may show long outcome.
authors.affiliation: Department of Urology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi 260-8670, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Tomioka
authors.forename: Masashi
authors.initials: M
authors.lastname: Shimbo
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Amiya
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Nakatsu
authors.forename: Shino
authors.initials: S
authors.lastname: Murakami
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality* / Q000473:pathology; D009376:Neoplasms, Hormone-Dependent / Q000097:blood / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen