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Increase of prostate-specific antigen doubling time predicts survival in metastatic castration-resistant prostate cancer patients undergoing radium therapy

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Abstract

Objective

Radium-223 (Ra-223) is an important treatment modality for bone-dominant metastatic castration-resistant prostate cancer (mCRPC). However, there is currently a lack of effective markers to monitor treatment response during treatment. We aim to investigate the response in prostate-specific antigen doubling time (PSADT) as a potential marker for assessing Ra-223 treatment in mCRPC patients.

Methods

We retrospectively collected data from mCRPC patients who underwent radium treatment at our institution between August 2020 and June 2023. Prostate-specific antigen (PSA) measurements prior to treatment and during treatment were collected. Baseline PSADT was calculated from PSA measurements prior to Ra-223 treatment; interim PSADT was calculated from PSA measurements before Ra-223 treatment and prior to the fourth course injection. Overall survival was calculated from the start of treatment to the date of death. Univariable and multivariable analysis using the Cox proportional hazards model were performed to examine the association of factors with overall survival.

Results

We included 35 patients from our institution, with a median overall survival of 13.3 months. Eighteen (51.4%) completed all six courses of treatment. PSA dynamic response (interim PSADT > baseline PSADT or decreased PSA) was observed in 20 patients. Overall survival was associated with a PSA dynamic response (HR = 0.318, 95% CI 0.133–0.762, p = 0.010) when compared to patients without response.

Conclusions

Dynamic changes in PSADT were associated with survival in mCRPC patients receiving radium therapy. Comparing interim and baseline PSADT could serve as a valuable marker for determining treatment benefits.

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Data availability

HL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Data are available for bona fide researchers who request it from the authors.

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Acknowledgements

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Medical Imaging, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

    Hsi-Huei Lu & Nan-Tsing Chiu

  2. Department of Radiation Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

    Mu-Hung Tsai

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Contributions

HL designed the study and performed data extraction; HL and MT performed statistical analysis and wrote the draft of the manuscript; NC provided administrative support. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mu-Hung Tsai.

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The authors declare no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board of National Cheng Kung University Hospital [B-ER-112-204], and the requirement of informed consent was waived due to the retrospective nature of the study.

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Lu, HH., Chiu, NT. & Tsai, MH. Increase of prostate-specific antigen doubling time predicts survival in metastatic castration-resistant prostate cancer patients undergoing radium therapy. Ann Nucl Med 38, 508–515 (2024). https://doi.org/10.1007/s12149-024-01924-6

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  • DOI: https://doi.org/10.1007/s12149-024-01924-6

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