Availability of local therapy to castration-resistant prostate cancer for mo patients with initial prostate specific antigen 100 ng/ml or higher

Prostate cancer patients with initial PSA 100 ng/ml or greater who received transrectal ultrasound- guided prostate biopsy and were staged as MO by imaging studies from 2011 to 2014 in seven hospitals, were enrolled in the study. Castration-resistant prostate cancer (CRPC)-free survival was compared between the two treatment groups: androgen deprivation therapy (ADT) alone and ADT plus local therapy. Of 142 prostate cancer patients with initial PSA 100 ng/ml or greater, 49 (34.5%) had no metastases and final analysis was performed on 46 patients. Thirty one M0 patients received ADT alone, and 15 received ADT plus local therapy. During follow-up (median 31 months, range 1-56 months) 13 patients (42%) in the ADT alone group progressed to CRPC. One- And two-year CRPC-free survival rates were 72.5 and 53%, respectively. No patients with ADT plus local therapy developed CRPC, and time to CRPC was prolonged significandy (p = 0.002). On multivariate analysis for the group with ADT alone, PSA nadir of more than 0. 2 ng/ml and cNl were independent predictors for progression to CRPC (p = 0.009, 0.031). About one third of prostate cancer patients with initial PSA 100 ng/ml or greater had clinically no metastases. Local therapy to prostate combined with ADT may prolong time to CRPC compared with ADT alone. A subset of men with a PSA nadir of more than 0.2 ng/ml after ADT and cNl could benefit from local therapy.