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Identifying Prostate Surface Antigen Patterns of Change in Patients with Metastatic Hormone Sensitive Prostate Cancer Treated with Abiraterone and Prednisone - Beyond the Abstract

While most patients with metastatic hormone-sensitive prostate cancer (mHSPC) will initially respond to androgen deprivation therapy (ADT) plus abiraterone acetate with prednisone (AA/P), the majority will develop castration-resistant disease. The ability to track early prostate-specific antigen (PSA) changes may alert clinicians to those more likely to progress and initiate subsequent therapies earlier before clinical or radiographic progression develops.

Historically with ADT alone or docetaxel-based chemotherapy, a non-detectable PSA at 7 months was considered a predictor of overall survival.1-2 However, there has not been a standard time frame established for patients treated with adrenal biosynthesis inhibitors.3-4 Our results showed a significant association between the degree of PSA decline at 3 months and serologic progression in mHSPC patients treated with ADT plus AA/P. Moreover, a PSA reduction < 98% from baseline and PSA > 3.0 ng/mL at 3 months were associated with a significantly shorter castration-resistant prostate cancer (CRPC)-free survival.

These findings support evaluating response to ADT plus AA/P for mHSPC as early as 3 months after initiation of therapy. Since castration-resistant disease is associated with high morbidity and mortality, it is important to identify patients with aggressive disease early to help maintain quality of life and prevent increased exposures to the healthcare system.

Written by: Iris Y Sheng, Jaleh Fallah, Ruby Gupta, Hong Li, Kimberly Allman, Allison Martin, Pedro Barata, Moshe C Ornstein, Timothy D Gilligan, Brian I Rini, Jorge A Garcia

Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA., Department of Hematology and Medical Oncology, Bellmunt Hospital, Troy, MI, USA., Department of Internal Medicine, Section of Hematology Oncology, Tulane University Medical School, New Orleans, LA, USA., Department of Internal Medicine, Section of Hematology Oncology, Vanderbilit University, Nashville, TN, USA., Department of Hematology Oncology, University Hospital Cleveland Medical Center, Cleveland, OH, USA.

References:

  1. Harshman LC, Chen Y-H, Liu G, et al. Seven-Month Prostate-Specific Antigen Is Prognostic in Metastatic Hormone-Sensitive Prostate Cancer Treated With Androgen Deprivation With or Without Docetaxel. J Clin Oncol 2017;36(4):376–82.
  2. Hussain M, Goldman B, Tangen C, et al. Prostate-specific antigen progression predicts overall survival in patients with metastatic prostate cancer: data from Southwest Oncology Group Trials 9346 (Intergroup Study 0162) and 9916. J Clin Oncol. 2009; 27(15):2450-2456. doi:10.1200/JCO.2008.19.9810Fizazi
  3. K, Tran N, Fein L, et al. Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 2017;377(4):352–60.
  4. Matsubara N, Chi KN, Özgüroğlu M, et al. Correlation of Prostate-specific Antigen Kinetics with Overall Survival and Radiological Progression-free Survival in Metastatic Castration-sensitive Prostate Cancer Treated with Abiraterone Acetate plus Prednisone or Placebos Added to Androgen Deprivation Therapy: Post Hoc Analysis of Phase 3 LATITUDE Study. Eur Urol 2019
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