A Study Of Prognosis On Endocrine Therapy Of Prostate Cancer

Object To research the risk factors in the endocrine therapy of prostate cancer progression to castration resistant prostate cancer(CRPC). To study the relationship between the dynamic changes of Prostate specific Antigen(Prostate specific Antigen, PSA) and outcomes in the Prostate cancer after endocrine therapy.Method Collecting the cases of prostate cancer by prostate biopsy in the first hospital affiliated Xiamen university hospital between January 2009 to May 2015.The univariate and multivariate of Logistic analysis, receiver operating characteristic(ROC) curve,Kaplan-Meier curves were used for analysising the prognostic factors of CRPC. Log-rank test was used to find the differences among groups(P<0.05).Results(1)All of the 124 patients were Confirmed by pathological biopsy and acceptted the Maximal Androgen Blockade(MAB) therapy with drug castration and bicalutamide(or flutamide). The range of the age is 39~91years old.the average age is 72.34±0.65 years old. 21 patients were in the stage of T1-2M0,34 patients were T3-4M0 and 69 patients were M1. The median follow-up time was 21 months, 22(17.7%) cases developed to be CRPC,6(4.6%) cases were died and 4(3.2%) cases were lost.(2)Univariate logistic analysis found that PSA before treament, Gleason score, normalization time of PSA, PSA after 3 months treament, PSA after 6 months treament,the valley value of the PSA, the valley time of the PSA,bone metastasis were possible risk factors of CRPC(P<0.05).(3)multivariate of Logistic analysis showed that the Gleason score,valley time of the PSA, PSA after 3 months treament, PSA after 6 months treamen were the independent risk factors of CRPC(P<0.05).Higher Gleason score, shortter valley time of the PSA,higher PSA after 3 months and 6months treatment lead to higher risk to be CRPC.(4)Drawing ROC curve for the independent risk factors, 4.99ng/ml is the proper cut-off of the PSA after 3 months with 57.1% sensitivity and 90.2% specificity.For the PSA after 6 months treatment, the cut-off is 1.64ng/ml with 81.8% sensitivity and 90.0 % specificity. And the proper cut-off of the valley time of PSA is 9 months with 62.7% sensitivity and 70.7% specificity.(5)The Kaplan-Meier indicated that the survival time without CRPC of patients with PSA after 3 months<4.99ng/ml is longger than that opposite group(Log-rank P<0.05).The prognosis of patients in PSA after 6 months < 1.64ng/ml is significantly better than ? 1.64ng/ml cases((Log-rank P<0.05).Besides,the patients of PSA vally time<9 months had poor prognosis than ?9 months(Log-rank P<0.001).Conclution 1. Gleason score, valley time of the PSA, PSA after 3 months treament, PSA after 6 months treamen were the independent risk factors of CRPC. 2.Higher Gleason score and shortter valley time of the PSA lead to higher risk to be CRPC. 3.Patients in the groups of PSA after 3 months ? 4.99ng/ml or PSA after 6 months ?1.64ng/ml has worse prognosis with shortter non-developing survival time. 4.The dynamic monitoring of PSA has important prodicting value in endocrine therapy of prostate cancer to be CRPC.