title: Optimal timing of hormonal therapy for prostate-specific antigen recurrence after radical prostatectomy.
abstract: The present study was undertaken to examine biochemical progression in patients who received salvage hormonal therapy (HT) for biochemical disease recurrence (BCR) after radical prostatectomy (RP), and to determine the optimal timing for the administration of HT. The study population consisted of 156 patients who underwent RP and received salvage HT for BCR. The starting point of this study was the timing of RP, and the endpoint was biochemical prostate-specific antigen (PSA) progression (castration-resistance) after HT. The mean follow-up period after surgery was 8.1 years. First, we excluded 18 patients with persistent PSA (≥ 0.2 ng/mL) after RP from an analysis below because their prognoses were significantly poorer compared with 138 patients whose PSA nadirs had reached <0.2 ng/mL. Multivariate analysis demonstrated that Gleason score ≥ 8 (p = 0.010, hazard ratio (HR) 3.02), and PSA doubling time (PSA-DT) <6 months (p = 0.001, HR 7.39) was independently associated with subsequent biochemical progression after HT. Using these two variables (Gleason score and PSA-DT), we could stratify patients into three risk groups for BCR after salvage HT. Regarding the optimal timing for HT administration for these high-risk patients with both risk factors (relative risk = 22.3), the PSA cutpoint of 1.0 ng/mL at the initiation of HT showed a significant difference in progression-free survival rates (p = 0.023). The findings indicated that for high-risk patients, salvage HT for BCR after PSA nadir (<0.2 ng/mL) should be started before the PSA level exceeds 1.0 ng/mL; otherwise, there is a significant risk of subsequent biochemical progression after HT.
authors.affiliation: Department of Urology, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Mizuno
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ide
authors.forename: Masanori
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishida
authors.forename: Nozomi
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Yota
authors.initials: Y
authors.lastname: Yasumizu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hagiwara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hara
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Akira
authors.initials: A
authors.lastname: Miyajima
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakajima
authors.forename: So
authors.initials: S
authors.lastname: Nakamura
authors.forename: Jun
authors.initials: J
authors.lastname: Nakashima
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen