title: Predictors of early androgen deprivation treatment failure in prostate cancer with bone metastases.
abstract: Approximately 15% of men with hormone naïve metastatic prostate cancer primarily fail to respond to androgen deprivation treatment (ADT). The reason why the response to ADT differs in this subgroup of men with prostate cancer remains unclear. The aim of this study was to describe the characteristics of these men and to thereby define predictors of early ADT failure in prostate cancer patients with bone metastases. The study was based on 915 men from the prospective randomized multicenter trial (no. 5) conducted by the Scandinavian Prostate Cancer Group comparing parenteral estrogen with total androgen blockade. Early ADT failure was defined as death from metastatic prostate cancer within 12 months after the start of ADT. Multivariate logistic regression models were applied to identify clinical predictors of early ADT failure. Ninety-four (10.3%) men were primarily nonresponders to ADT. Independent predictors of early ADT failure were poor Eastern Cooperative Oncology Group performance status (PS), analgesic consumption, low hemoglobin, and high Soloway score (extent of disease observed on the scan), in where patients with poor PS and/or high analgesic consumption had a threefold risk of early ADT failure. Not significantly factors related to early ADT failure were age, treatment, cardiovascular comorbidity, T category, grade of malignancy, serum estrogen level, and SHBG at enrolment. We analyzed characteristics of a subgroup of patients who primarily failed to respond to ADT. Four independent clinical predictors of early ADT failure could be defined, and men exhibiting these features should be considered for an alternative treatment.
authors.affiliation: Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Varenhorst
authors.affiliation: Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Rami
authors.initials: R
authors.lastname: Klaff
authors.affiliation: EpiStat, Uppsala, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Berglund
authors.affiliation: Department of Urology, Karolinska Institute, Solna, Sweden.
authors.forename: Per Olov
authors.initials: PO
authors.lastname: Hedlund
authors.affiliation: Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Hospital Huddinge, Huddinge, Sweden.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D005485:Flutamide / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy; D012044:Regression Analysis; D012307:Risk Factors; D017211:Treatment Failure; D017329:Triptorelin Pamoate / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017329:Triptorelin Pamoate; D005485:Flutamide
keywords: Androgen deprivation treatment; bone metastases; clinical predictors; early failure; prostate cancer