Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
World J Urol. 2024 Oct 29;42(1):604. doi: 10.1007/s00345-024-05316-3.
No study has compared cancer regression (d) and growth (g) rates in patients with advanced castration-sensitive prostate cancer (CSPC) treated with androgen deprivation therapy. The comparison of d and g rates provides insight into the differential impact of ADT regimens on tumor dynamics, potentially guiding more personalized treatment strategies. Therefore, we aimed to estimate these rates and evaluate their impact on survival outcomes.
Sequential prostate-specific antigen (PSA) data was obtained from the KYUCOG-1401 trial including patients with advanced CSPC randomized to gonadotropin-releasing hormone (GnRH) antagonist (group A) and GnRH agonist plus bicalutamide (group B). d and g rates were estimated by applying mathematical models and were compared in subgroups. PSA-progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival (OS) were compared by lower and higher than the median of these rates.
Patients with higher PSA and higher extent of disease score at enrollment presented higher d rates (0.03965 vs. 0.03546, p = 0.0006) and (0.03947 vs. 0.03587, p = 0.0113) for groups A and B, respectively. The median d rate was lower for group A than group B (0.03306 vs. 0.039965, respectively [p = 0.0002]). The median g rate was higher for group A than group B (0.00016 vs. 0.00002, respectively [p = 0.0014]). The g rate, but not the d rate discriminated PSA-PFS, rPFS, and OS.
Our results suggest that GnRH agonist plus bicalutamide reduced PSA level faster and suppressed PSA rising longer than GnRH antagonist. Moreover, measuring the g rate can predict PSA-PFS, rPFS, and OS in patients with advanced CPSC treated with androgen deprivation therapy. These findings suggest that incorporating g rate measurements into clinical practice could improve prognostic accuracy and guide treatment decisions in advanced CSPC.
尚无研究比较接受雄激素剥夺治疗的晚期去势敏感前列腺癌（CSPC）患者的肿瘤退缩（d）和生长（g）率。比较 d 和 g 率可以深入了解 ADT 方案对肿瘤动力学的不同影响，可能为更个体化的治疗策略提供指导。因此，我们旨在估计这些率并评估其对生存结果的影响。
从 KYUCOG-1401 试验中获取了包括接受 GnRH 拮抗剂（A 组）和 GnRH 激动剂加比卡鲁胺（B 组）治疗的晚期 CSPC 患者的连续前列腺特异性抗原（PSA）数据。通过应用数学模型来估计 d 和 g 率，并在亚组中进行比较。通过低于和高于这些率的中位数来比较 PSA 无进展生存期（PSA-PFS）、放射学无进展生存期（rPFS）和总生存期（OS）。
入组时 PSA 较高和疾病程度评分较高的患者呈现出更高的 d 率（A 组为 0.03965 比 0.03546，p=0.0006；B 组为 0.03947 比 0.03587，p=0.0113）。A 组的中位 d 率低于 B 组（分别为 0.03306 和 0.039965，p=0.0002）。A 组的中位 g 率高于 B 组（分别为 0.00016 和 0.00002，p=0.0014）。g 率而非 d 率可区分 PSA-PFS、rPFS 和 OS。
我们的结果表明，与 GnRH 拮抗剂相比， GnRH 激动剂加比卡鲁胺可更快降低 PSA 水平并更长时间抑制 PSA 升高。此外，测量 g 率可以预测接受雄激素剥夺治疗的晚期 CPSC 患者的 PSA-PFS、rPFS 和 OS。这些发现表明，将 g 率测量纳入临床实践可以提高晚期 CSPC 的预后准确性并指导治疗决策。
