Medical management in locally advanced and metastatic prostate cancer: Does changes in treatment policy have any specific effect on PSA levels?

  • Murat Bagcioglu | dr.muratbagcioglu@hotmail.com Urology Department, Kafkas University Faculty of Medicine, Kars, Turkey.
  • Cristian Surcel Fundeni Clinical Institute, Center of Urologic Surgery and Renal Transplantation, Bucharest, Romania.
  • Serkan Ozcan Urology Department Artvin State Hospital, Artvin, Turkey.
  • Cristian Mirvald Fundeni Clinical Institute, Center of Urologic Surgery and Renal Transplantation, Bucharest, Romania.
  • Mehmet Ali Karagoz Urology Department Ankara Research and Training Hospital, Ankara, Turkey.
  • Mert Ali Karadag Urology Department Kafkas University Faculty of Medicine, Kars, Turkey.
  • Emre Huri Urology Department Hacettepe University, Faculty of Medicine, Ankara, Turkey.
  • Kemal Sarica Urology Department Kartal Research and Training Hospital, Istambul, Turkey.

Abstract

Objective: Androgen deprivation therapy (ADT) is commonly used as a first-line treatment for locally advanced and metastatic prostatic cancer (Pca). There is no consensus about which alternative treatment should be used after the failure of initial ADT. We aimed to investigate the effect of changes in treatment on PSA and testosterone levels. Material and methods: A total of 120 patients with an established diagnosis of either locally advanced or metastatic Pca in two different centers. Depending on the type of medical and/or surgical management protocol planned at initial presentation, all cases were divided into three main groups as follows. Group 1 (n: 80) included the patients who underwent medical management during whole follow-up period in whom the initial management protocol was later on switched to another medical treatment with different agents, Group 2 (n: 20) included patients who were initially treated with a medical management protocol and switched to surgical castration during follow-up evaluation and lastly Group 3 (n: 20) included the patients undergoing treated surgical castration as initial treatment modality without any further medical management protocol. Results: Evaluation of our data did clearly demonstrate a statistically significant difference between the initial and final PSA as well as testosterone levels in Group 1 cases. Mean PSA and testosterone levels increased significantly in these cases despite a change in hormonal therapy by using another agent for androgen deprivation. Cases in Group 2 and 3 cases did not show any statistically significant difference with respect to the mean PSA as well as testosterone values during the same follow-up period. Conclusions: Our data clearly indicated that in case of a biochemical progression, switching into another alternative medical treatment was not effective enough in limiting the rising PSA levels in a statistically significant manner when compared with the approaches of switching to surgical castration after initial medical treatment or continuing with regular and close follow-up after initial surgical castration alone.

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Published
2017-12-31
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Section
Original Papers - Prostate
Keywords:
Prostat cancer, PSA, Hormonal therapy, Treatment changes
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How to Cite
Bagcioglu, M., Surcel, C., Ozcan, S., Mirvald, C., Karagoz, M., Karadag, M., Huri, E., & Sarica, K. (2017). Medical management in locally advanced and metastatic prostate cancer: Does changes in treatment policy have any specific effect on PSA levels?. Archivio Italiano Di Urologia E Andrologia, 89(4), 282-286. https://doi.org/10.4081/aiua.2017.4.282