Correlation Research Between The Early Dynamic Change Of PSA And The Prognosis After Treatment With Abiraterone Acetate For Castration-resistant Prostate Cancer

Objective:Report on the dynamic changes of PSA in the early stage after treatment with abiraterone acetate（AA）for castration-resistant prostate cancer（CRPC）,and explore the correlation between the dynamic changes of PSA in the early stage and the overall survival（OS）of patients,for early screening of high-risk patients and early Intervene in disease progression to provide a theoretical basis.Methods:The clinical data of 47 CRPC patients treated with AA from December 1,2016to August 31,2020 were retrospectively analyzed,and the dynamic changes of PSA in the early stage after AA treatment were summarized.The dynamic changes of early PSA are mainly based on the PSA response degree△after 1,2,and 3 months of AA treatment（the baseline PSA value at the start of AA treatment minus the PSA value after 1,2,and 3 months of AA treatment and the baseline PSA value Ratio）to reflect.The degree of PSA response△is divided by 50%.In the first month,the PSA value drops≥50%as the high△₁ group,and the PSA value drops less than50%as the low△₁ group;the same applies to the second and third months.Univariate Cox regression analysis was performed for the factors that might affect OS,and multivariate Cox regression analysis was performed for the indicators with statistically significant differences.Survival analysis was performed by Kaplan-Meier method,and significance test was performed by Log-rank method.Results:The results of multivariate COX regression analysis showed:age at first visit（HR=3.697,95%CI:1.157-11.813,P=0.027）and bone metastasis EOD score at the start of AA treatment（HR=6.080,95%CI:1.389-26.610,P=0.017）is an independent risk factor for the prognosis of CRPC patients treated with AA.The older the age at first diagnosis and the higher the EOD score of bone metastases at the beginning of AA treatment,the shorter the patient’s OS.After 1 month of AA treatment,low△₁group VS high△₁group（HR=5.343,95%CI:1.353～21.097,P=0.017）,so PSA response degree△₁ is an independent protective factor,indicating The greater the decrease in PSA value after one month of AA treatment,the longer the patient’s OS.The P value of PSA response degree△₂（P=0.597）after AA treatment for 2 months and PSA response degree△₃（P=0.157）after AA treatment for 3 months was greater than 0.1 in the univariate COX regression analysis,which was statistically insignificant.The results of the KM survival curve suggest that the OS of patients aged less than 75.5 years and more than 75.5 years old at the first diagnosis was（31.0±2.5）months and（18.3±2.7）months,respectively,and the difference was statistically significant（P=0.043,?²=4.080）;The OS of patients with bone metastasis EOD score>1.5 and<1.5 at the beginning of AA treatment was（21.5±3.3）months and（28.6±1.8）months,respectively,the difference was statistically significant（P=0.010,?²=6.605）;After 1 month of AA treatment,the OS of patients with high△₁ and low△₁ in PSA response△₁ was（28.1±2.0）months and（22.1±3.3）months,respectively,the difference was statistically significant（P=0.016,?²=5.835）.Conclusion:For CRPC patients treated with AA,age at first diagnosis,bone metastasis EOD score at the start of AA treatment,and PSA response degree△1 after AA treatment are independent prognostic factors for OS.The higher the age at the first diagnosis and the higher the EOD score of bone metastases at the beginning of AA treatment,the worse the prognosis of the patient and the shorter the OS;the PSA response degree△₁ is a protective factor for OS after 1 month of AA treatment,and the prognosis of patients with△₁≥50%is better.Therefore,AA treatment of CRPC patient needs to closely monitor the patient’s PSA dynamic level,and its change value has a certain predictive significance,and provides the possibility for early intervention and prolonged survival.