Value of PSA dynamic changes in predicting prostate cancer progression to castration-resistant prostate cancer after androgen deprivation therapy

doi:10.3877/cma.j.issn.1674-3253.2025.04.010

Abstract

Abstract:

Objective

To analyse the predictive value of dynamic changes of prostate specific antigen (PSA), fPSA and f/tPSA on the prognosis of prostate cancer (PCa) patients after androgen deprivation therapy (ADT).

Methods

A total of 519 patients diagnosed with PCa by prostate biopsy were selected from the database of Henan Provincial People's Hospital. All patients received ADT treatment and had not received any other form of prostate cancer-related treatment previously, with regular follow-up conducted. Finally, 78 patients progressed to castration-resistant prostate cancer (CRPC). The relationship between PSA nadir (PSAn), time from ADT to PSA nadir (TTPN), bone metastasis score, fPSA nadir (fPSAn) and CRPC was calculated by COX analysis, and the optimal cut-off value was calculated by receiver operating characteristic curve, and finally its feasibility was verified by K-M analysis.

Results

Bone metastasis score, TTPN, PSAn and whether PSA decreased to undetectable levels, fPSAn, TTFPN, f/tPSA before treatment and f/tPSA peak time were independent risk factors for PCa patients to progress to CRPC. The smaller the PSAn, the longer the TTPN, TTFPN, the peak time of f/tPSA, the longer the patient's progression to CRPC, and the optimal cut-off value obtained by ROC curve was PSAn: 0.214 ng/mL, TTPN: 14.5 months, fPSAn: 0.04 ng/mL, TTFPN: 10.5 months, and f/tPSA peak time: 19 months.

Conclusion

Dynamic changes in prostate-specific antigen can effectively predict the risk of progression to castration-resistant prostate cancer in prostate cancer patients after androgen deprivation therapy, providing evidence for clinical prognosis assessment.

Key words: Prostate cancer, PSA, ADT, Prognostic analysis

Yibo Xue, Guanhua Jing, Hao Xu, Yuntian Zhang, Kunpeng Shu, Honglin Shi. Value of PSA dynamic changes in predicting prostate cancer progression to castration-resistant prostate cancer after androgen deprivation therapy[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(04): 454-459.

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References 25

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	单因素			多因素
	HR值	P值	95%CI	HR值	P值	95%CI
年龄(岁)	0.972	0.035	0.947~0.998	1.010	0.512	0.980~1.041
BMI (kg/m²)	1.014	0.743	0.935~1.099
TNM分期(低转移=0，高转移=1)	1.272	0.269	0.831~1.947
EOD评分(分)	1.738	<0.001	1.323~2.282	1.520	0.011	1.101~2.099
病理类型(腺癌=0，导管内癌=1)	0.813	0.775	0.197~3.350
Gleason评分(分)	1.102	0.501	0.830~1.463
前列腺体积(ml)	1.005	0.170	0.998~1.012
治疗前PSA (ng/mL)	1.000	0.495	1.000~1.000
TTPN (月)	0.848	<0.001	0.806~0.891	0.696	<0.001	0.609~0.795
PSAn (ng/mL)	1.024	0.012	1.005~1.044	1.033	0.032	1.003~1.065
PSA是否下降至无法检测的水平(否=0，是=1)	0.554	0.049	0.308~0.996	0.062	<0.001	0.022~0.177
fPSA (治疗前，ng/mL)	1.002	0.062	1.000~1.004
fPSAn (ng/mL)	1.190	0.001	1.074~1.318	0.999	0.989	0.837~1.192
TTFPN (月)	0.876	<0.001	0.835~0.919	0.967	0.470	0.884~1.058
f/tPSA（治疗前）	21.35	0.010	2.095~217.584	5.909	0.141	0.556~62.784
f/tPSA峰值	0.891	0.579	0.592~1.340
f/tPSA达峰时间(月)	0.974	0.006	0.956~ 0.993	1.046	0.009	1.011~1.082

	单因素			多因素
	HR值	P值	95%CI	HR值	P值	95%CI
年龄(岁)	0.972	0.035	0.947~0.998	1.010	0.512	0.980~1.041
BMI (kg/m²)	1.014	0.743	0.935~1.099
TNM分期(低转移=0，高转移=1)	1.272	0.269	0.831~1.947
EOD评分(分)	1.738	<0.001	1.323~2.282	1.520	0.011	1.101~2.099
病理类型(腺癌=0，导管内癌=1)	0.813	0.775	0.197~3.350
Gleason评分(分)	1.102	0.501	0.830~1.463
前列腺体积(ml)	1.005	0.170	0.998~1.012
治疗前PSA (ng/mL)	1.000	0.495	1.000~1.000
TTPN (月)	0.848	<0.001	0.806~0.891	0.696	<0.001	0.609~0.795
PSAn (ng/mL)	1.024	0.012	1.005~1.044	1.033	0.032	1.003~1.065
PSA是否下降至无法检测的水平(否=0，是=1)	0.554	0.049	0.308~0.996	0.062	<0.001	0.022~0.177
fPSA (治疗前，ng/mL)	1.002	0.062	1.000~1.004
fPSAn (ng/mL)	1.190	0.001	1.074~1.318	0.999	0.989	0.837~1.192
TTFPN (月)	0.876	<0.001	0.835~0.919	0.967	0.470	0.884~1.058
f/tPSA（治疗前）	21.35	0.010	2.095~217.584	5.909	0.141	0.556~62.784
f/tPSA峰值	0.891	0.579	0.592~1.340
f/tPSA达峰时间(月)	0.974	0.006	0.956~ 0.993	1.046	0.009	1.011~1.082

	HR值	P值	95%CI
PSA (ng/mL)
年龄(岁)	1.003	0.813	0.975~1.032
EOD评分(分)	1.483	0.011	1.097~2.007
TTPN (月)	0.725	<0.001	0.660~0.796
PSAn (ng/mL)	1.034	0.004	1.011~1.057
PSA是否下降至无法检测的水平(否=0，是=1)	0.068	<0.001	0.025~0.187
fPSA (ng/mL)
年龄(岁)	1.002	0.910	0.973~1.031
EOD评分(分)	1.763	<0.001	1.339~2.320
TTFPN (月)	0.857	<0.001	0.810~0.907
fPSAn (ng/mL)	1.164	0.011	1.035~1.310
f/tPSA (ng/mL)
年龄(岁)	0.977	0.119	0.948~1.006
EOD评分(分)	1.897	<0.001	1.440~2.498
治疗前f/tPSA	10.07	0.049	1.014~100.026
f/tPSA达峰时间(月)	0.975	0.010	0.957~0.994

	HR值	P值	95%CI
PSA (ng/mL)
年龄(岁)	1.003	0.813	0.975~1.032
EOD评分(分)	1.483	0.011	1.097~2.007
TTPN (月)	0.725	<0.001	0.660~0.796
PSAn (ng/mL)	1.034	0.004	1.011~1.057
PSA是否下降至无法检测的水平(否=0，是=1)	0.068	<0.001	0.025~0.187
fPSA (ng/mL)
年龄(岁)	1.002	0.910	0.973~1.031
EOD评分(分)	1.763	<0.001	1.339~2.320
TTFPN (月)	0.857	<0.001	0.810~0.907
fPSAn (ng/mL)	1.164	0.011	1.035~1.310
f/tPSA (ng/mL)
年龄(岁)	0.977	0.119	0.948~1.006
EOD评分(分)	1.897	<0.001	1.440~2.498
治疗前f/tPSA	10.07	0.049	1.014~100.026
f/tPSA达峰时间(月)	0.975	0.010	0.957~0.994

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