The value of tumor markers in men with metastatic prostate cancer undergoing [177 Lu]Lu-PSMA therapy.

Yordanova, Anna; Linden, Paula; Hauser, Stefan; Feldmann, Georg; Brossart, Peter; Fimmers, Rolf; Essler, Markus; Holdenrieder, Stefan; Ahmadzadehfar, Hojjat

doi:10.1002/pros.23912

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journal article

Title:: The value of tumor markers in men with metastatic prostate cancer undergoing [177 Lu]Lu-PSMA therapy.
Document type:: Article; Journal Article
Author(s):: Yordanova, Anna; Linden, Paula; Hauser, Stefan; Feldmann, Georg; Brossart, Peter; Fimmers, Rolf; Essler, Markus; Holdenrieder, Stefan; Ahmadzadehfar, Hojjat
Abstract:: BACKGROUND: Currently, prostate-specific membrane antigen-radioligand therapy (PSMA-RLT) is considered a last-line treatment option in advanced castration-resistant prostate cancer. Despite these patients' poor prognosis, accurate estimation of their overall survival (OS) is essential to determine whether benefits exist from the treatment and whether the loss of valuable time and unnecessary side effects can be avoided. The aim of the present study is to evaluate whether various biochemical markers can predict OS in men undergoing PSMA-RLT and whether the changes assessed after PSMA-RLT correlate with the OS. METHODS: The tested tumor markers in this retrospective analysis were alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BAP), prostate-specific antigen (PSA), lactate dehydrogenase (LDH), chromogranin A, and pro-gastrin-releasing peptide (pro-GRP). For the evaluation, we performed blood tests before each PSMA-RLT cycle and during follow-up visits (which were 2-3 months apart). All patients were followed up until their deaths. To test the correlations between the tumor markers and survival, we conducted the logrank tests and the multivariate Cox proportional-hazards regression model. The significance level was set at P < .05. RESULTS: The study included 137 patients who received a total of 487 PSMA-RLT cycles between January 2015 and November 2017. Of the tested biochemical tumor markers, baseline ALP (120 U/L cut-off), LDH (248 U/L cut-off), and PSA (first quartile cut-off) correlated significantly with survival post-PSMA-RLT (P < .001 for ALP and LDH, and P = .007 for PSA). Stable and/or decreased values in most of the initially abnormal parameters were associated with significantly better OS; these parameters were ALP (P = .009), LDH (P = .005), PSA (P < .001), and pro-GRP (P = .013). The BAP and ALP responses also correlated significantly with survival in patients with bone metastases (P = .002 and P < .001, respectively). Furthermore, there was a strong correlation of the kinetic patterns of PSA, ALP, BAP, and LDH with the survival, showing that patients with steadily increasing markers had the shortest OS. CONCLUSION: Along with the established tumor marker PSA, ALP, LDH, BAP, and pro-GRP were correlated with the OS post-PSMA-RLT in the univariate and multivariate analyses.
Journal title abbreviation:: Prostate
Year:: 2020
Journal volume:: 80
Journal issue:: 1
Pages contribution:: 17-27
Fulltext / DOI:: doi:10.1002/pros.23912
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31579967
Print-ISSN:: 0270-4137
TUM Institution:: Institut für Laboratoriumsmedizin (keine SAP-Zuordnung!)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Institut für Laboratoriumsmedizin (DHM) (Prof. Holdenrieder)2020