PRETHERAPEUTIC ERYTHROCYTE POLYAMINE SPERMINE LEVELS DISCRIMINATE HIGH-RISK RELAPSING PATIENTS WITH M1 PROSTATE CARCINOMA

BAGKGROUND. Androgen deprivation is currently the standard treatment f or patients with metastatic prostate carcinoma. Few reliable prognosti c markers are able to select, at diagnosis, patients who will respond favorably and durably to hormone ablation. Circulating polyamines, mar kers of cell proliferation that are elevated in prostate carcinoma, ha ve been evaluated as a prognostic tool. METHODS. Eighty-eight patients with untreated, M1 classified prostate carcinoma who received endocri ne therapy between 1988 and 1993 were included in this study. Performa nce status, hemoglobin, alkaline phosphatases, prostate specific antig en, Gleason tumor grade, extent of disease by bone scan, and circulati ng erythrocyte spermidine and spermine were correlated with observed p rogression free and cause-specific survivals. Multiple correspondence analysis and ascending hierarchical classification were performed to d etermine significant pretreatment prognostic factors. RESULTS, Pretrea tment performance status, alkaline phosphatase, hemoglobin, and erythr ocyte spermine levels were correlated with progression, with hemoglobi n and erythrocyte spermine level being the most significant independen t variables (P < 0.00001 and P < 0.0001, respectively). With regard to cause specific survival, only hemoglobin and spermine erythrocyte lev els were significant independent variables (P < 0.0001 and P < 0.0005, respectively). Patients with spermine levels of less than 9 nmo1/8-10 (9) had a statistically better outcome than patients with 9 nmol/8-10( 9) or more erythrocytes. Erythrocyte spermine was the best sole determ inant of progression. A test combining spermine with performance statu s or hemoglobin improved each variable's predictive values. CONCLUSION S, Circulating erythrocyte spermine levels, extracted from a blood sam ple, can discriminate, at diagnosis, patients with hormone-refractory from those with hormone-responsive metastatic prostate carcinoma. (C) 1996 American Cancer Society.