1
|
Sidhu A, Khan N, Phillips C, Briones J, Kapoor A, Zalewski P, Fleshner NE, Chow E, Emmenegger U. Prevalence and Prognostic Implications of PSA Flares during Radium-223 Treatment among Men with Metastatic Castration Resistant Prostate Cancer. J Clin Med 2023; 12:5604. [PMID: 37685670 PMCID: PMC10488545 DOI: 10.3390/jcm12175604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Radium-223 (Ra233) prolongs the survival of men with symptomatic bone-predominant metastatic castration-resistant prostate cancer (mCRPC). However, prostate-specific antigen (PSA) response patterns are not closely associated with Ra223 therapy outcomes. Herein, we sought to analyze the impact of Ra223-induced PSA flares on patient outcome. Using a retrospective cohort study of Ra223 treatment in four Ontario/Canada cancer centres, we identified 134 patients grouped into sub-cohorts according to distinct PSA response patterns: (i) initial PSA flare followed by eventual PSA decline; (ii) PSA response (≥30% PSA decrease within 12 weeks of treatment); and (iii) PSA non-response. We analyzed patient characteristics and outcome measures, including overall survival (OS), using the Kaplan-Meier method and log-rank testing. PSA flares were observed in 27 (20.2%), PSA responses in 11 (8.2%), and PSA non-responses in 96 (71.6%) patients. Amongst PSA flare patients, 12 presented with post-flare PSA decreases below baseline and 15 with PSA decreases below the flare peak but above baseline. Although only six flare patients achieved ≥30% PSA decreases below baseline, the median OS of all flare patients (16.8 months, 95% CI 14.9-18.7) was comparable to that of PSA responders and non-responders (p = 0.349). In summary, around 20% of mCRPC patients experience Ra223-induced PSA flares, whose outcome is similar to that of men with or without PSA responses. Further studies are needed regarding suitable biochemical surrogate markers of response to Ra223.
Collapse
Affiliation(s)
- Amanjot Sidhu
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Nabeeha Khan
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Cameron Phillips
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Juan Briones
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Anil Kapoor
- Juravinski Cancer Centre, Hamilton, ON L8V 5C2, Canada;
| | - Pawel Zalewski
- Durham Regional Cancer Centre, Oshawa, ON L1G 2B9, Canada;
| | | | - Edward Chow
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Urban Emmenegger
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| |
Collapse
|
2
|
Kobayashi H, Shiota M, Sato N, Kobayashi S, Matsumoto T, Monji K, Kashiwagi E, Takeuchi A, Inokuchi J, Shiga KI, Yokomizo A, Eto M. Differential prognostic impact of complete blood count-related parameters by prior use of novel androgen receptor pathway inhibitors in docetaxel-treated castration-resistant prostate cancer patients. Anticancer Drugs 2022; 33:e541-e547. [PMID: 34387597 DOI: 10.1097/cad.0000000000001170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are multiple reports on the value of complete blood count (CBC)-related parameters on prognosis in docetaxel-treated castration-resistant prostate cancer (CRPC) patients before the emergence of androgen receptor pathway inhibitors (ARPIs). We investigated the prognostic significance of CBC-related parameters in docetaxel-treated CRPC patients. Patients treated with docetaxel chemotherapy for CRPC between 2008 and 2018 were included. We analyzed the relevance of CBC-related parameters to oncological prognosis in docetaxel chemotherapy, associated with prior use of novel ARPIs. Among 144 Japanese men treated with docetaxel, 49 men (34.0%) had already received ARPI therapy. A high neutrophil-lymphocyte ratio (NLR) was a prognostic factor for poor progression-free survival and overall survival (OS) in both univariate and multivariate analyses. In addition, a low hemoglobin (Hb) level and a high systemic immune-inflammation index (SII) were prognostic factors of poor OS in univariate analysis. Hb level was a prognostic factor of OS in both ARPI-naive and ARPI-treated patients. However, a high NLR and SII were only associated with a poor prognosis in ARPI-naive but not in ARPI-treated patients. Hb, NLR, and SII have been suggested to be prognosticators in docetaxel-treated CRPC patients. The differential prognostic value of NLR and SII between ARPI-naive and ARPI-treated patients may require caution when using these markers in docetaxel-treated CRPC patients.
Collapse
Affiliation(s)
- Hiroki Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | - Nobuaki Sato
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Satoshi Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | - Keisuke Monji
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| | | | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
3
|
Prognostic significance of risk stratification in CHAARTED and LATITUDE studies among Japanese men with castration-resistant prostate cancer. Prostate Int 2022; 10:7-13. [PMID: 35229000 PMCID: PMC8844649 DOI: 10.1016/j.prnil.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
Background The CHAARTED and LATITUDE trials demonstrated a survival benefit of docetaxel and abiraterone for hormone-sensitive prostate cancer. In this study, we examined the impact of the risk stratification criteria used in the CHAARTED and LATITUDE trials on the prognosis of castration-resistant prostate cancer (CRPC). We also tested whether these risk stratification criteria could help in selecting effective initial treatment for CRPC. Method Japanese patients with CRPC who were treated with docetaxel or androgen receptor pathway inhibitors such as abiraterone acetate or enzalutamide between 2014 and 2018 were included in this study. Clinicopathological factors, progression-free survival, and overall survival were investigated. Results Of 215 patients, 110 men (51.2%) and 93 men (43.3%) were grouped as high volume by CHAARTED criteria and high risk by LATITUDE criteria, respectively. Median progression-free survival was 10.3/4.5 months (P < 0.0001) for low/high volume (CHAARTED criteria) and 9.9/4.8 months (P = 0.0032) for low/high risk (LATITUDE criteria). The median overall survival was 44.8/17.4 months (P < 0.0001) for low/high volume (CHAARTED criteria) and 37.4/17.4 months (P = 0.0011) for low/high risk (LATITUDE criteria). The prognostic impact of CHAARTED and LATITUDE criteria was comparable between androgen receptor pathway inhibitors and docetaxel as first-line treatment for CRPC. Conclusion The CHAARTED and LATITUDE criteria were prognostic, but not useful to discriminate the therapeutic outcome between androgen receptor pathway inhibitors and docetaxel for CRPC.
Collapse
|
4
|
Shiota M, Blas L, Kobayashi S, Matsumoto T, Kashiwagi E, Takeuchi A, Inokuchi J, Shiga KI, Yokomizo A, Eto M. Predictive factors of survival outcomes in first-line therapy for metastatic castration-resistant prostate cancer. Int J Urol 2021; 29:26-32. [PMID: 34549837 DOI: 10.1111/iju.14702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/01/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate predictive factors of survival of metastatic castration-resistant prostate cancer patients undergoing first-line treatment with androgen receptor pathway inhibitors or docetaxel. METHODS Japanese patients with metastatic castration-resistant prostate cancer treated with androgen receptor pathway inhibitor or docetaxel between 2008 and 2018 were included. The differential impact of various clinicopathological factors on the outcome, including progression-free survival and overall survival, was compared between treatment with androgen receptor pathway inhibitor and docetaxel. RESULTS Of 254 patients with metastatic castration-resistant prostate cancer, 119 (46.9%) and 135 (53.2%) were treated with androgen receptor pathway inhibitor and docetaxel, respectively. The multivariate analysis showed that androgen receptor pathway inhibitor was an independent prognostic factor for better progression-free survival (hazard ratio 0.62, 95% confidence interval 0.42-0.92, P = 0.016) and overall survival (hazard ratio 0.61, 95% confidence interval 0.41-0.93, P = 0.021), compared with docetaxel. Pretreatment prostate-specific antigen levels and time to castration-resistant prostate cancer were differentially associated with progression-free survival and overall survival between androgen receptor pathway inhibitor or docetaxel. In patients who presented <6 months to castration-resistant prostate cancer, progression-free survival was shorter in those treated with androgen receptor pathway inhibitor (median 1.1 months, 95% confidence interval 0.2-2.8 months) compared with those who received docetaxel (median 5.0 months, 95% confidence interval 1.8-6.7 months; P = 0.014). CONCLUSIONS First-line therapy with androgen receptor pathway inhibitor is associated with a better prognosis when compared with docetaxel, even after adjustment for prognostic factors. However, a shorter time to castration-resistant prostate cancer is associated with better progression-free survival for patients receiving docetaxel, suggesting that docetaxel is the preferred option for patients with a shorter time to castration-resistant prostate cancer.
Collapse
Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Leandro Blas
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Satoshi Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| |
Collapse
|
5
|
Abstract
To investigate the value of the 1.5T magnetic resonance imaging (MRI) apparent diffusion coefficient (ADC) and the prostate imaging reporting and data system (PI-RADS) score in prostate cancer (PCa) screening.Forty PCa patients diagnosed by pathology from December 2014 to September 2018 were recruited as the PCa group; 60 patients with benign prostatic hyperplasia (BPH) were recruited as the benign group. Patients from both groups underwent 1.5T MRI scanning. The prostate ADC values, exponential apparent diffusion coefficient (eADC) values, and PI-RADS scores of patients from the 2 groups were compared. The different methods for PCa diagnosis were compared.The ADC values of patients in the PCa group were significantly lower than those in the benign group, whereas the eADC values of patients were significantly higher than those in the benign group, with statistically significant differences (P < .05). The differences in the PI-RADS scores of patients from the 2 groups were statistically significant (P < .05). Receiver Operating Characteristic (ROC) curve results showed that the ADC value combined with the PI-RADS score was superior to the ADC value or the PI-RADS score alone in sensitivity, specificity, and Youden index for PCa diagnosis. By comparing the area under the curve (AUC) of each ROC curve from the different diagnostic methods, the combination of ADC value and PI-RADS score showed the largest area.The ADC value from 1.5T MRI combined with the PI-RADS score could be used as the standard for PCa screening, which would effectively improve screening for PCa and be valuable for clinical applications.
Collapse
Affiliation(s)
| | - Lianqiang Shan
- Department of Radiology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | | | | | | |
Collapse
|
6
|
Ceci F, Polverari G, Calais J, Castellucci P. The influence of PSA flare in mCRPC patients treated with alpha-emitting radiopharmaceuticals. Eur J Nucl Med Mol Imaging 2018; 45:2253-2255. [DOI: 10.1007/s00259-018-4162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Hanna F, Prakash A, Allan E, Khalafallah AA. Successful treatment of concomitant metastatic prostate cancer and B-cell non-Hodgkin's lymphoma with R-EPOCH chemotherapy regimen and antiandrogen therapy. BMJ Case Rep 2018; 2018:bcr-2017-223637. [PMID: 29549134 DOI: 10.1136/bcr-2017-223637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 70-year-old man presented with left loin pain without urinary symptoms. Initial investigations with CT showed enlarged para-aortic, mediastinal lymph nodes, right-side renal mass and enlarged prostate. A prostatic-specific antigen (PSA) was alarmingly high at 4750 μg/L (normal <4.0 μg/L). Further investigations included positron emission tomography (PET); both prostate-specific membrane antigen and 18-fluorodeoxyglucose as well as bone scan and bone marrow examination confirmed dual malignancies with B-cell non-Hodgkin's lymphoma (B-NHL) and wide spread metastatic prostatic adenocarcinoma (PA) to the skull, spine, pelvis, liver and lungs. The patient was treated with six cycles of rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin(R-EPOCH) containing regimen for B-NHL and goserelin hormonal therapy for PA. Restaging with PET scans thereafter showed complete remission of NHL with disappearance of his metastatic PA and normalisation of PSA levels. R-EPOCH regimen and antiandrogen therapy resulted in a good outcome and remission of both malignancies.
Collapse
Affiliation(s)
- Fayez Hanna
- Faculty of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Ajay Prakash
- Haematology, Tasmanian Medical Laboratory, Launceston, Tasmania, Australia.,Haematology Department, Specialist Care Australia, Launceston, Tasmania, Australia
| | - Ebony Allan
- Haematology Department, Specialist Care Australia, Launceston, Tasmania, Australia
| | - Alhossain A Khalafallah
- Faculty of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia.,Haematology Department, Specialist Care Australia, Launceston, Tasmania, Australia.,Launceston General Hospital, Launceston, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Launceston, Tasmania, Australia
| |
Collapse
|
8
|
Conteduca V, Caffo O, Lolli C, Aieta M, Scarpi E, Bianchi E, Maines F, Schepisi G, Salvi S, Massari F, Carrozza F, Veccia A, Chiuri VE, Campadelli E, Facchini G, De Giorgi U. Long-term clinical impact of PSA surge in castration-resistant prostate cancer patients treated with abiraterone. Prostate 2017; 77:1012-1019. [PMID: 28429372 DOI: 10.1002/pros.23357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Early changes in PSA have been evaluated in association to treatment outcome. The aim of this study was to assess PSA surge phenomenon in castration-resistant prostate cancer (CRPC) patients treated with abiraterone and to correlate those variations with long-term treatment outcome. PATIENTS AND METHODS We retrospectively evaluated 330 CRPC patients in 11 Italian hospitals, monitoring PSA levels at baseline and every 4 weeks. Other clinical, biochemical and molecular parameters were determined at baseline. We considered PSA surge as PSA increase within the first 8 weeks from starting abiraterone more than 1% from baseline followed by a PSA decline. The log-rank test was applied to compare survival between groups of patients according to PSA surge. The impact of PSA surge on survival was evaluated by Cox regression analyses. RESULTS A total of 330 patients with CRPC, median age 74 years (range, 45-90), received abiraterone (281 chemotherapy-treated and 49 chemotherapy-naïve). PSA surge was observed in 20 (7%) post-chemotherapy and 2 (4%) chemotherapy-naïve patients. For overall patients presenting PSA surge, timing of PSA peak from baseline was 5 ± 1.8 weeks and PSA rise from baseline was 21 ± 18.4%. The overall median follow-up was 23 months (range 1-62). No significant differences in progression-free survival and overall survival were observed between patients with and without PSA surge (P = 0.16 and =0.86, respectively). In addition, uni- and multivariate analyses showed no baseline factors related to PSA surge. CONCLUSION PSA surge occurs in both chemotherapy-treated and chemotherapy-naïve patients treated with abiraterone resulting, however, in no long-term impact on outcome. Physicians and patients should be aware of PSA surge challenge to prevent a premature discontinuation of potentially effective therapy with abiraterone. Further larger and prospective studies are warranted to investigate this not infrequent phenomenon.
Collapse
Affiliation(s)
- Vincenza Conteduca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Cristian Lolli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Michele Aieta
- Medical Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Emanuela Scarpi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | | | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Giuseppe Schepisi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Samanta Salvi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | | | | | - Antonello Veccia
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | | | | | - Gaetano Facchini
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| |
Collapse
|
9
|
Kessler ER. What is behind the flare phenomenon? BJU Int 2016; 118:845-846. [PMID: 27870361 DOI: 10.1111/bju.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth R Kessler
- Division of Medical Oncology, University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|