Clinical predictors of androgen-independent prostate cancer and survival in the prostate-specific antigen era

Objectives. To further characterize and identify novel predictors of androgen-independent prostate cancer (AIPC) and survival in the prostate-specific antigen (PSA) era. Methods. A total of 184 consecutive patients with prostate cancer receiving chronic androgen suppression were assessed for the development of AIPC and overall survival. Results. The median time to development of AIPC was 44 months (Stage M+ = 24 months; Stage MO = 63 months, P = 0.000001). The 10-year overall survival rate for Stage MO or M disease was 89% and 55%, respectively. AIPC developed significantly more commonly in patients with a higher nadir PSA level (greater than 1 ng/dL), a longer time to reach nadir PSA (greater than 3 months), a larger body mass index (greater than 27 kg/m(2)), greater pretherapy PSA level, and when evidence of metastatic disease was identified (logistic regression analysis). Overall survival was significantly associated with advanced stage (skeletal metastases), pretreatment PSA level, and history of skeletal fracture (multivariate Cox regression analysis). Conclusions. In the PSA era, longer intervals of androgen suppression therapy in nonmetastatic, biochemically recurrent prostate cancer have translated into a change in the duration of androgen-dependent prostate cancer. Although the duration of androgen dependence remains variable, prolonged-possibly ''curative"-control exists in a subset of patients. Obese men developed AIPC significantly sooner than did slender men, A skeletal fracture was a significant negative predictor of overall survival. These observations form the basis for nomogram predictions of AIPC in the PSA era. (C) 2002, Elsevier Science Inc.