Identification of favorable subgroups for alternative anti‑androgen therapy in castration‑resistant prostate cancer

Suzuki,Kotaro; Terakawa,Tomoaki; Shigemura,Katsumi; Furukawa,Junya; Harada,Kenichi; Hinata,Nobuyuki; Nakano,Yuzo; Fujisawa,Masato

doi:10.3892/mco.2019.1915

Identification of favorable subgroups for alternative anti‑androgen therapy in castration‑resistant prostate cancer

Authors:
- Kotaro Suzuki
- Tomoaki Terakawa
- Katsumi Shigemura
- Junya Furukawa
- Kenichi Harada
- Nobuyuki Hinata
- Yuzo Nakano
- Masato Fujisawa
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Affiliations: Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650‑0017, Japan
Published online on: August 27, 2019 https://doi.org/10.3892/mco.2019.1915
Pages: 523-530

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Abstract

Although alternative anti‑androgen therapy (switching to secondary anti‑androgens) is no longer recommended in the clinical guidelines of prostate cancer in light of the new hormonal and cytotoxic agents available, this therapy has proven beneficial for some patients with castration‑resistant prostate cancer (CRPC). The objective of this study was to identify favorable subgroups for alternative anti‑androgen therapy among CRPC patients. Eighty‑eight consecutive CRPC patients treated with alternative anti‑androgen therapy were included in this study. All patients were treated with bicalutamide in the initial maximum androgen blockade (MAB) and switched to flutamide in the subsequent alternative anti‑androgen therapy, combined with a luteinizing hormone‑releasing hormone analogue. Several clinical and pathological factors for predicting the prostate‑specific antigen (PSA) decline and PSA progression‑free survival (PSA‑PFS) of alternative anti‑androgen therapy were investigated. Of all patients, 45 (51.1%) patients showed ≥50% PSA decline. The median PSA‑PFS was 7.5 months [95% confidence interval (CI), 5.7‑10.3]. Notably, 15 (17.0%) patients had a PSA‑PFS over 2 years. A multivariate analysis showed that ≥3 bone metastatic lesions and a duration <12 months of initial MAB were significant factors shortening the duration of PSA‑PFS, with hazard ratios of 2.11 (95% CI, 1.23‑3.62; P=0.007) and 2.08 (95% CI, 1.20‑3.57; P=0.008), respectively. Patients without any of these factors had a median PSA‑PFS of 22.8 months (95% CI, 6.7‑48.8). The overall survival in patients with a ≥7.5‑month PSA‑PFS receiving alternative anti‑androgen therapy was significantly longer than that of patients with a <7.5‑month PSA‑PFS (109.1 vs. 40.8 months; P<0.001). In conclusion, a longer duration of initial MAB and the absence of severe bone metastasis may predict a favorable response to alternative anti‑androgen therapies in CRPC patients. Alternative anti‑androgen therapy may still be beneficial for these patients, but this needs to be investigated further.

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