Prostate-specific antigen nadir and cancer-specific mortality following hormonal therapy for prostate-specific antigen failure

Purpose For men receiving androgen-suppression therapy (AST) for a rising postoperative or postradiation prostate-specific antigen (PSA), we evaluated whether a PSA nadir of more than 0.2 ng/mL was significantly associated with prostate cancer-specific mortality (PCSM). Patients and Methods The study cohort comprised 747 men with rising PSA and negative bone scan after surgery (n = 486) or radiation therapy (n = 261) who were treated with AST. Cox regression was used to evaluate whether a significant association existed between the PSA nadir level after 8 months of AST and the time to PCSM, controlling for treatment and known prognostic factors. Results The post-AST PSA nadir (p(Cox) < .0001), the pre-AST PSA doubling time (DT) (p(Cox) = .002), PSA level (P = .0001), and Gleason eight to 10 cancers (p(Cox) = .01) were significantly associated with time to PCSM. The adjusted hazard ratio for PCSM was 20 (95% Cl, 7 to 61; P-Cox < .0001), for men with a PSA nadir of more than 0.2 ng/mL as compared with all others. A PSA DT of less than 3 months was observed in 30% (224 of 747) of the study cohort. Of the 28 observed prostate cancer deaths, 21 (75%) occurred in men whose PSA nadir was more than 0.2 ng/mL and who had a PSA DT of less than 3 months. Conclusion A PSA nadir of more than 0.2 ng/mL after 8 months of AST given for postoperative or postradiation PSA failure is significantly associated with PCSM and is clinically significant because it accounted for 75% of the cancer deaths observed in this study.