Can PSA surge impact hormone-resistant prostate cancer in the long-term?

The authors aimed to determine the impact of prostate specific antigen (PSA) surge in hormone-resistant prostate cancer patients following abiraterone acetate (Zytiga) treatment.

The authors concluded that PSA surge occurred in both chemotherapy-treated and chemotherapy-naïve patients treated with abiraterone acetate with no long-term impact on outcome. Doctors should be aware of PSA surge in order to avoid discontinuation with potentially effective therapies. 

Hormone therapy is a treatment that targets the male sex hormones, such as testosterone. Some men main develop a resistance to this treatment, known as hormone-resistant prostate cancer.  Abiraterone acetate is a common treatment used in hormone-resistant cancer. It functions by preventing the production of enzymes needed for cancer cell growth. Prednisone (Deltasone) is another treatment used in patients with low levels of corticosteroids that functions by replacing steroids naturally made by the body. These treatments are often used in combination.

PSA is a protein elevated in the blood in the presence of prostate cancer. PSA surges are an initial increase in PSA levels above the normal levels after abiraterone acetate treatment, followed by a PSA decline.

Further research is needed to determine the long-term impact of PSA surges in hormone-resistant prostate cancer patients treated with abiraterone acetate.

The aim of this study was to determine the long-term effects of PSA surges in men treated with abiraterone acetate.

330 patients were used in this study who received abiraterone acetate after previous treatments. The average follow-up was 23 months. 281 patients in group 1 received abiraterone acetate after chemotherapy. 49 patients in group 2 received abiraterone acetate but were chemotherapy-naïve (did not receive chemotherapy).

PSA surge was found in 20 patients in group 1 and 2 patients in group 2. 87.9% of patients in group 1 experienced disease progression. In group 1 PSA surge was not associated with progression-free survival (PFS – time from treatment until disease progression) or overall survival (time from treatment until death from any cause). There was no significant difference in PFS and overall survival between patients with and without PSA surge. 

The authors concluded that PSA surge occurred in both chemotherapy-treated and chemotherapy-naïve patients treated with abiraterone acetate with no long-term impact on outcome. Doctors should be aware of PSA surge in order to avoid discontinuation with potentially effective therapies.