PROGNOSTIC VALUE OF PROSTATE-SPECIFIC ANTIGEN MINIMUM AFTER ORCHIECTOMY IN PATIENTS WITH STAGE-C AND STAGE-D PROSTATIC-CARCINOMA

Objective To determine the significance of the minima of prostate-spec ific antigen (PSA) levels after orchidectomy in patients with advanced carcinoma of the prostate (stage C and D disease), to thereby discrim inate patients who have a statistically significant difference in prog nosis and thus individualize their adjuvant treatment. Patients and me thods A retrospective analysis of 50 patients (mean age 75.8 years) wi th extracapsular prostate cancer (58% stage C, 42% stage D disease) wa s performed. PSA measurement and clinical assessment were continued at 3-monthly intervals until there was evidence of clinical progression, The minimum values of PSA were determined, the patients grouped at in tervals of 1 ng/mL, and the groups compared statistically on the basis of disease progression. Results Serum PSA levels decreased in all pat ients to a minimum after 3-6 months. There was a statistically signifi cant difference in the probability of, and time to, disease progressio n for PSA minima at 1 ng/mL and 10 ng/mL. Of the 13 patients in group 1 (with PSA minima. <1 ng/mL), 11 stayed in remission during a mean fo llow-up duration of 45.9 months. Of 25 patients in group 2 (with PSA m inima between 1 and 10 ng/mL) 19 developed progression after a mean re mission period of 16.7 months, while all 12 patients in group 3 (with PSA minima >10 ng/mL) progressed after a mean remission period of 12.5 months. Conclusion Post-orchidectomy PSA minima are an excellent prog nostic factor with significant predictive value. While patients in gro up 1 tend to have a favourable prognosis after orchidectomy alone, gro up 2 and 3 patients need adjuvant treatment as early as possible. Grou p 3 patients, with their high probability of early progression, also f orm a uniform cohort for studies concerning new therapeutic modalities . If the PSA minimum was Included in further examinations, the results of treatment should improve.