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Systematic Review

Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis

[version 1; peer review: 1 approved, 2 approved with reservations]
Andika Afriansyah
https://orcid.org/0000-0002-5079-0691
1, Agus Rizal Ardy Hariandy Hamid
https://orcid.org/0000-0002-7538-2811
1, Chaidir Arif Mochtar1, Rainy Umbas1
Andika Afriansyah
https://orcid.org/0000-0002-5079-0691
1, Agus Rizal Ardy Hariandy Hamid
https://orcid.org/0000-0002-7538-2811
1, Chaidir Arif Mochtar1, Rainy Umbas1
PUBLISHED 28 Feb 2018
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

Aim: Metastatic prostate cancer (mPCa) has a poor outcome with median survival of two to five years. The use of androgen deprivation therapy (ADT) is a gold standard in management of this stage.  Aim of this study is to analyze the prognostic value of PSA kinetics of patient treated with hormonal therapy related to survival from several published studies
Method: Systematic review and meta-analysis was performed using literature searching in the electronic databases of MEDLINE, Science Direct, and Cochrane Library. Inclusion criteria were mPCa receiving ADT, a study analyzing Progression Free Survival (PFS), Overall Survival (OS), or Cancer Specific Survival (CSS) and prognostic factor of survival related to PSA kinetics (initial PSA, PSA nadir, and time to achieve nadir (TTN)). The exclusion criteria were metastatic castration resistant of prostate cancer (mCRPC) and non-metastatic disease. Generic inverse variance method was used to combine hazard ratio (HR) within the studies. Meta-analysis was performed using Review Manager 5.2 and a p-value <0.05 was considered statistically significant.
Results: We found 873 citations throughout database searching with 17 studies were consistent with inclusion criteria. However, just 10 studies were analyzed in the quantitative analysis. Most of the studies had a good methodological quality based on Ottawa Scale. No significant association between initial PSA and PFS. In addition, there was no association between initial PSA and CSS/ OS. We found association of reduced PFS (HR 2.22; 95% CI 1.82 to 2.70) and OS/ CSS (HR 3.31; 95% CI 2.01-5.43) of patient with high PSA nadir. Shorter TTN was correlated with poor result of survival either PFS (HR 2.41; 95% CI 1.19 – 4.86) or CSS/ OS (HR 1.80; 95%CI  1.42 – 2.30)
Conclusion: Initial PSA before starting ADT do not associated with survival in mPCa.  There is association of PSA nadir and TTN with survival

Keywords

androgen deprivation therapy, metastasis, PSA kinetics, prostate cancer, survival, systematic review, meta analysis

Corresponding author: Rainy Umbas
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2018 Afriansyah A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).
How to cite: Afriansyah A, Hamid ARAH, Mochtar CA and Umbas R. Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis [version 1; peer review: 1 approved, 2 approved with reservations]. F1000Research 2018, 7:246 (https://doi.org/10.12688/f1000research.14026.1) First published: 28 Feb 2018, 7:246 (https://doi.org/10.12688/f1000research.14026.1) Latest published: 28 Feb 2018, 7:246 (https://doi.org/10.12688/f1000research.14026.1)

Introduction

Prostate cancer (PCa) is the second most common cancer in men, and the fourth most common cancer worldwide. More than one million men worldwide were diagnosed with PCa in 20121. The incidence of local-regional PCa has increased since the introduction of prostate specific antigen (PSA). This circumstance reduces the incidence of metastatic PCa2. PCa patient treated at early stages have a good prognosis with 5-year overall survival (OS) reaching 99%. In contrast, metastatic PCa patients generally experience a poor outcome. Several published studies showed a wide difference of survival, with median OS from two to five years3–5. Androgen deprivation therapy (ADT) becomes the standard treatment of patients with advanced PCa6,7, and with the first use reported by Huggins and Hodges in 19418.

In clinical practice, PSA is the most common diagnostic procedure to evaluate the disease and to predict the survival. PSA kinetics such as nadir PSA level, time to reach nadir (TTN), or specific PSA value after initiation of ADT might became a predictor of survival in several retrospective and clinical trial studies5,9–11. Some limitations were shown in the previous report of investigation for PSA kinetic to survival. They included patients with heterogeneous backgrounds (such as metastatic disease prior to surgical or radiation therapy), and the sample size was small. Therefore, we performed a systematic review and meta-analysis to evaluate the pooled effect of PSA kinetics of patient treated with hormonal therapy related to survival from several published studies.

Methods

Eligibility criteria

The systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines12. All studies in English were included. Retrospective cohorts, prospective cohort, randomized clinical trial (RCT), were eligible for inclusion for this review. The inclusion criteria were that (i) the participant of the study had metastatic PCa; (ii) patients were treated with ADT either using orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist with or without anti-androgen (AA); (iii) the studies outcome were either progresion free survival (PFS), overall survival (OS) or cancer specific survival (CSS); (iv) the studies had to analyze PSA kinetics (intial PSA prior to initiation of ADT, PSA nadir, and time to reach nadir (TTN) PSA). Studies analyzed in meta-analysis had to use adjusted analysis of prognostic factors, such as multivariate Cox regression, to overcome the confounding factors. Studies that analyzed patient with castration resistant PCa (CRPC) and non-metastatic disease were excluded.

Search strategy

Electronic searched were performed in three databases: MEDLINE, Science Direct, and Cochrane Library from 1950 to 2016. This literature searching was conducted in March 2017. Gray literature and conference abstract, especially from urology oncology conference, were also searched. References list from included article were reviewed. We used the following search strategy: (prostate cancer OR adenocarcinoma prostate), (survival OR prognosis OR prognostic), (metastasis OR metastases OR metastatic), (PSA OR “Prostate Specific Antigen” OR nadir OR “initial PSA” OR kinetic). Two researchers (A.A and A.R.A.H) were indecently assessing the title and abstract of the paper. They agreed the studies included in the meta-analysis. Disagreement between the two review authors on the selection of studies was resolved by discussion with third authors (C.A.M) as a senior investigator. We used EndNote X6 for screening of duplicated studies.

Data extraction and quality assessment

A data extraction table was created to extract data from each article. The data of study design, patient's characteristics, method of ADT, duration of follow up, outcomes of survival, and significant prognostic factors of PSA kinetics were collected from all included studies. For the observational studies, the quality of study was assessed using Newcastle-Ottawa Scale (NOS). There were three major components of this scale namely the selection of the group of the study, comparability, and assessment of the outcome. The quality of study assessed with number of stars based on NOS. A maximum 7 stars could be scored; 6 or 7 stars considered as high quality study, 4 – 5 stars corresponded with intermediate quality, and 0 – 3 stars showed low quality13.

Synthesis of results

Meta-analysis was applied on studies with prognostic factor with similar outcome definition. I2 test was conducted in order to evaluate the heterogeneity, whilst for >30% a random effects model was applied, or otherwise, fixed effects model was done. Confounding in the individual studies was estimated using Hazard Ratio (HR) adjusted estimation, thus generic inverse variance method was used. We only combined data to estimate pooled effect of categorical parameters due to feasibility of statistical analysis. Studies that evaluated parameters but could not synthesize to meta-analysis were describe quantitatively. Meta-analysis was performed using Review Manager 5.2 from Cochrane Collaboration. A p-value < 0.05 was considered statistically significant.

Results

We found 873 citations throughout database searching. No additional records identified through searching from reference list of included studies. Seventeen studies were found to be consistent to the inclusion criteria of the study, but seven studies could not be evaluated the in meta-analysis (Figure 1). Miyamoto et al.14 did not published the hazard ratio, and put the cumulative survival rate as the outcome. Six other studies used numerical parameters of PSA kinetics that cannot combine in the forest plot9,15–19. All of those studies were considered in qualitative synthesis. The characteristic of study is present in Table 1. Based on NOS, the quality of study included was good (Table 2).

6354474f-6094-4be0-baa2-85d357fcb35b_figure1.gif

Figure 1. Flowchart showing the searching strategy of the studies.

Table 1. Characteristic of included studies.

StudyTotal
patient		Androgen Deprivation
Therapy		Follow - up timeSurvival outcomeSignificance Prognostic
Factor
Bello 201725M1 = 79•   Orchiectomy
•   LHRH agonist		NMMedian OS was 40.3 months•   NSAID use
•   PSA nadir
Choueiri 20095M1 = 179•   LHRH agonist with or
    without AA
•   Orchiectomy		Median follow up
48 months		Median OS was 84 months•   GS
•   TTN
•   PSA Nadir
Glass 20039M1 = 1,076Bilateral orchiectomy with
or without AA (flutamide)		NMMedian OS was 32 months•   Initial PSA
•   Presence appendicular
    bone disease
•   GS
•   Presence of bone pain
•   PS
Hong 201210M1 = 131CAB using LHRH agonist
plus AA		Median follow up
30 months		Median CSS
•   PSA nadir < 2 ng/ml
    was 91.7 months
•   PSA nadir ≥ 2 ng/ml 49.8		•   PSA nadir
•   TTN
Hussain 200611M1 = 1,345CAB using LHRH agonist
(gosereline) plus AA
(bicalutamide)		Median follow up
was 38.0 months		Median OS of PSA after
7 months ADT
•   ≤ 0.2 ng/ml was
    75 months
•   0.2 < PSA ≤ 0.2 ng/ml
    was 44 months
•   PSA > 4.0 ng/ml was
    13 months		•   PSA after 7 months
    of ADT
•   ECOG
•   Presence of bone pain
•   GS
Kadono Y, 20154M1a = 224,
M1b = 4386,
M1c =278		•   LHRH agonist with or
    without AA
•   Orchiectomy		Mean follow up
3.3 years		The 5-year OS was
•   57.5% in M1a
•   54.0% in M1b
•   40.0% in M1c		•   GS
•   PSA
•   Age
Kim KH, 201518M1 = 398•   CAB (LHRH agonist
    plus AA)		Median follow up
44 months		Median CSS was 65 months•   GS
•   PSA nadir
•   TTN
•   PSA Half Life
•   N1
Kimura, 201424M1 = 3006•   Type of ADT was not
    clear		Median followed
up in young,
middle and
elderly group
was 25.5, 35.3
and 38.5 months		The 5-years OS
•   Young age was 26.6%
•   Middle age was 59.7%
•   Elderly age was 55.3%		•   GS
•   Concomitant bone and
    visceral metastasis
•   Age
•   Clinical T
Koo, 201417M1b = 248•   Type of ADT was not
    clear		Median follow up
39.3 months		Median CSS in PSA nadir
•   < 0.2 ng/ml was
    70 months
•   ≥ 0.2 ng/ml was
    50 months		•   PSA nadir
•   ALP
•   ECOG
Kwak 200223M1 = 145•   LHRH agonist with or
    without AA
•   Orchiectomy		Median follow up
39 months		Median survival of patients
with Nadir PSA (months)
•   < 0.2, = 53
•   0.2 to 1.0 = 42
•   1.1 to 10 = 24
•   >10.1 = 15		•   Nadir PSA
Miller 199225M1 = 48
patients		•   Orchiectomy
•   LHRH agonist
•   Diethylatibestrol		Median follow up
42 months		Median PFS 19 months•   Nadir PSA
Miyamoto 14M1 – 94•   LHRH agonist with AAMedian follow up
38.8 months		5-yr OS rate 62.5%•   PSA
•   Gleason Grade
Nayyar 2010 16M1 = 412•   Surgical castration
•   Medical castration
•   Antiandrogen		Median follow up
55 months		Median OS 5.7 years•   GS
•   PSA doubling time
Park, 200915M1 = 131•   LHRH agonist with or
    without AA
•   Orchiectomy		Median follow up
was 53.0 months		Median CSS
•   Short PSA doubling
    time was 35 months
•   Long PSA doubling
    time 95 months		•   High Nadir PSA
•   Short PSA half time
•   Short PSA doubling
    time after nadir
Sasaki 2011 22M1 = 412•   Bilateral orchiectomy
•   LHRH agonist		NMMedian OS 5.7 years•   PSA half time
•   PSA doubling time
•   GS
Teoh 2017 21M1b = 419•   LHRH agonist
•   Bilateral orchiectomy		Median follow up
was 48 months		Median OS was 28 months•   PSA nadir ≥ 2 ng/ml
•   TTN < 9.09 months
Tomiokoa 201420M1 = 236•   LHRH agonist
•   surgical castration
•   AA monotherapy
•   CAB		Median follow up
47 months		The 5-years OS was 63%•   Nadir PSA ≥ 0.2 ng/ml
•   TTN < 6 month

ADT = androgen deprivation therapy; LHRH = luteinizing hormone releasing hormone; AA = anti androgen; CAB = combined anti androgen; PSA = prostate specific antigen; OS = overall survival; GS = Gleason score; TTN = time to nadir; NM = not mentioned; NSAID = non-steroidal anti inflammatory drug; ECOG PS = Eastern Cooperative Oncology Group Performance Status; PS = Performance Status; ALP = alkaline phosphatase; N1= regional nodal metastasis

Table 2. Methodological quality of the study based on NOS Scale.

StudySelection
(Max ****)		Comparability
(Max **)		Outcome
(Max ***)		Total
Score
Representativeness
of exposed cohort		Selection
of exposed
cohort		Ascertainment
of exposure		No outcome
of interest at
start 		Comparability of
cohorts on the basis
of design of analysis		Assessment
of outcome		Was follow-up
long enough
for outcomes
to occur		Adequacy of
follow up of
cohorts
Bello 201725*******Not clearNot clear7
Choueiri 20095********9
Glass 20039*******Not clear Not clear7
Hong 201210*********9
Hussain 200611*********9
Kadono 20154*********9
Kim 201518*********9
Kimura 201424********8
Koo 201417*********9
Kwak 2002*********9
Miller 199219********8
Miyamoto
201214		*********9
Nayyar 2010*********9
Park 200915*********9
Sasaki 201122*******-*7
Teoh 201721*********9
Tomioka 201420*********9

Evaluation of PSA kinetics

Initial PSA. Initial PSA before ADT treatment was evaluated in twelve studies4,9–11,16,17,19–25. However, we only put four studies in PFS outcome and four studies in CSS/OS outcome because the studies analyzed initial PSA as a categorical parameter. No significant association between initial PSA and PFS was found, and the studies were homogenous (I2=0%). In addition, there was no association between initial PSA and CSS/OS (Figure 2). In qualitative analysis, four studies analyzed the association between initial PSA and PFS. All of the studies did not find significant results for PSA and PFS16,17,19,25. The result was the same when we analyzed the studies for OS/CSS outcome9,11,16.

6354474f-6094-4be0-baa2-85d357fcb35b_figure2.gif

Figure 2.

Forest plot of association between initial PSA and: A) Progression Free Survival Outcome; B) Cancer Specific Survival/Overall Survival.

PSA Nadir. Six studies analyzed the effect of PSA nadir to influence survival using 0.2 ng/ml as a cut-off point5,10,11,20,22,23. Four studies analyzed the PSA nadir as a continuous variable15,17–19. Teoh et al. used cut-off point 2 ng/ml as a PSA nadir that influence the survival21. Bello et al. analysed nadir using 4 ng/ml as a threshold25. Meta-analysis of the studies found an association of reduced PFS of patient with high PSA nadir (HR 2.22; 95% CI 1.82 to 2.70). The studies appear homogenous in the forest plot. In addition, high PSA nadir had a negative impact on the OS/CSS outcome with HR 3.31 (95% CI 2.01–5.43) (Figure 3). In the studies using continuous measurement of PSA nadir, three studies found significant association of nadir PSA and survival15,18,19. However, studies by Koo et al. found no significant result17. Miyamoto et al. found the PSA nadir after first line hormonal therapy influenced survival14.

6354474f-6094-4be0-baa2-85d357fcb35b_figure3.gif

Figure 3.

Forest plot of association between PSA nadir and: A) Progression Free Survival Outcome; B) Cancer Specific Survival/Overall Survival.

Time to Nadir (TTN). A total of seven studies analyzed the relationship between TTN and survival5,10,16–18,20,21. Of the seven studies, two studies used 8 months5,10, one study used 9 months26, and one study used 12 months20 as a cut-off. Three studies analyzed TTN as a continuous variable16–18. Meta-analysis was performed with showing a shorter TTN correlated with poor survival for both PFS (HR 2.41; 95% CI 1.19 – 4.86) or CSS/OS (HR 1.80; 95%CI 1.42 – 2.30) (Figure 4). Studies using continuous variable of TTN showed a significant negative effect from shorter TTN on survival.

6354474f-6094-4be0-baa2-85d357fcb35b_figure4.gif

Figure 4.

Forest plot of association between TTN and: A) Progression Free Survival Outcome; B) Cancer Specific Survival/Overall Survival.

Dataset 1.Dataset 1. Quality assessment (based on NOS), hazard ratio, and standard error of studies included in initial PSA parameter.
http://dx.doi.org/10.5256/f1000research.14026.d195553For quality assessment a maximum 7 stars could be scored; 6 or 7 stars considered as high quality study, 4 – 5 stars corresponded with intermediate quality, and 0 – 3 stars showed low quality.
Dataset 2.Dataset 2. Quality assessment (based on NOS), hazard ratio, and standard error of studies included in PSA nadir parameter.
http://dx.doi.org/10.5256/f1000research.14026.d195573For quality assessment a maximum 7 stars could be scored; 6 or 7 stars considered as high quality study, 4 – 5 stars corresponded with intermediate quality, and 0 – 3 stars showed low quality.
Dataset 3.Dataset 3. Quality assessment (based on NOS), hazard ratio, and standard error of studies included in time to nadir parameter.
http://dx.doi.org/10.5256/f1000research.14026.d195577For quality assessment a maximum 7 stars could be scored; 6 or 7 stars considered as high quality study, 4 – 5 stars corresponded with intermediate quality, and 0 – 3 stars showed low quality.

Discussion

Nowadays, clinicians have use PSA not only for screening for PCa, but also for follow up of patients after the treatment. The PSA indicates PCa condition following radical treatment in localized disease, and hormonal treatment in metastatic condition. PSA has a prognostic value, and now has been widen to several parameters such as PSA nadir, TTN, PSA doubling time, and PSA response after the treatment. There is controversy among previous study about the utilization of the PSA kinetic after hormonal treatment for predicting the progression to CRPC and survival.

The meta-analysis performed in this study did not find an association between survival and high initial PSA. Significant heterogeneity was observed due to scattered cut off points of high initial PSA amongst the studies included. Several studies found significant association of initial PSA and survival in univariate analysis, but lost significant after multivariate analysis. This condition showed us the aggressiveness of the cancer has not reflected by PSA alone, and other measures such as Gleason score, PSA nadir, and PSA decline may need to be considered10,15. This finding was different in localized diseases. High initial PSA reflects disease burden and was found to be correlated with the pathological stage, Gleason score, and the risk of metastasis. The National Comprehensive Cancer Network (NCCN) guideline stratified the risk of localized disease based on PSA and that influences the treatment choice27.

The significant findings of this study showed that lower PSA nadir was associated with good prognosis after ADT treatment. However, due to the variety of PSA nadir threshold, we could not conclude the best optimal threshold of PSA nadir. Most of the papers in this meta-analysis were using below 0.2 ng/ml PSA nadir. Morote et al. analyzed 185 patients with metastatic prostate cancer and they found nadir PSA above 0.2 ng/ml was associated with 20 times likelihood progression to CRPC28. Moreover, Stewart et al. analyzed patient who received ADT due to biochemical recurrence after radical prostatectomy or radiation therapy, and they suggested PSA nadir above 0.2 ng/ml was associated with significant progression and mortality29. Keizman et al. used a different cut off for PSA nadir. They were using below 0.1 ng/ml because they found 4 times increased likelihood of biochemical or clinical progression in patients treated with intermittent ADT due to relapse after radical treatment30.

Our findings found an association between longer time to get nadir PSA and survival. Longer time to nadir was associated with good prognosis. A study by Chung et al. found longer time to achieve nadir was a good prognosis for postoperative or post-radiation failure patients receiving ADT31. Possible mechanisms of longer time to nadir associated with a good prognosis was associated with differentiation of PCa cells. Rapid reduction of hormone sensitive cancer cells may induce an environment for the development of hormone resistant PCa cells. In addition, PCa cells that have potential to differentiate into castration resistant cell show a rapid reduction of PSA due to ablation of the androgen receptor. Thus, rapid reduction of PSA is associated to development of CRPC and has a poor prognosis32. This phenomenon is opposite to organ confined PCa receiving radical prostatectomy. In this setting, rapid decline of PSA result is associated with a better prognosis33.

This study has some methodological limitations. We did not analyze the method of administration of ADT due to heterogeneity of ADT administration and that might be influenced survival. Some of the PSA kinetics evaluated in this meta-analysis had significant high heterogeneity. The strengths of this study include (i) a high quality of study based on NOS scale; (ii) meta-analysis just included study with multivariate analysis (iii) several parameters that were associated with the survival were found in this study and might be evaluated in the future research.

Conclusion

In this study, the intial PSA before administering ADT did not influence the PFS or OS/CSS. Higher PSA nadir during ADT treatment was associated with shortened progression time and survival. A longer time to nadir is a good prognosis of progression and survival of mPCA treated with ADT.

Data availability

Dataset 1. Quality assessment (based on NOS), hazard ratio, and standard error of studies included in initial PSA parameter. For quality assessment a maximum 7 stars could be scored; 6 or 7 stars considered as high quality study, 4 – 5 stars corresponded with intermediate quality, and 0 – 3 stars showed low quality. 10.5256/f1000research.14026.d19555334

Dataset 2. Quality assessment (based on NOS), hazard ratio, and standard error of studies included in PSA nadir parameter. For quality assessment a maximum 7 stars could be scored; 6 or 7 stars considered as high quality study, 4 – 5 stars corresponded with intermediate quality, and 0 – 3 stars showed low quality. 10.5256/f1000research.14026.d19557335

Dataset 3. Quality assessment (based on NOS), hazard ratio, and standard error of studies included in time to nadir parameter. For quality assessment a maximum 7 stars could be scored; 6 or 7 stars considered as high quality study, 4 – 5 stars corresponded with intermediate quality, and 0 – 3 stars showed low quality. 10.5256/f1000research.14026.d19557736

Competing interests

No competing interests were declared.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Supplementary material

Supplementary File 1: Completed PRISMA checklist.

Click here to access the data.

References

  • 1.  Ferlay J, Soerjomataram I, Ervik M, et al.: GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 Lyon, France: International Agency for Research on Cancer, 2013; [cited 2016 11 January]. Reference Source
  • 2.  Buzzoni C, Auvinen A, Roobol MJ, et al.: Metastatic Prostate Cancer Incidence and Prostate-specific Antigen Testing: New Insights from the European Randomized Study of Screening for Prostate Cancer. Eur Urol. 2015; 68(5): 885–90. PubMed Abstract | Publisher Full Text | Free Full Text
  • 3.  Tangen CM, Faulkner JR, Crawford ED, et al.: Ten-year survival in patients with metastatic prostate cancer. Clin Prostate Cancer. 2003; 2(1): 41–5. PubMed Abstract | Publisher Full Text
  • 4.  Kadono Y, Nohara T, Ueno S, et al.: Validation of TNM classification for metastatic prostatic cancer treated using primary androgen deprivation therapy. World J Urol. 2016; 34(2): 261–7. PubMed Abstract | Publisher Full Text
  • 5.  Choueiri TK, Xie W, D'Amico AV, et al.: Time to prostate-specific antigen nadir independently predicts overall survival in patients who have metastatic hormone-sensitive prostate cancer treated with androgen-deprivation therapy. Cancer. 2009; 115(5): 981–7. PubMed Abstract | Publisher Full Text | Free Full Text
  • 6.  Heidenreich A, Bastian PJ, Bellmunt J, et al.: EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014; 65(2): 467–79. PubMed Abstract | Publisher Full Text
  • 7.  Mohler JL, Kantoff PW, Armstrong AJ, et al.: Prostate cancer, version 2.2014. J Natl Compr Canc Netw. 2014; 12(5): 686–718. PubMed Abstract | Publisher Full Text
  • 8.  Huggins C, Hodges C: Studies on prostatic cancer II. The effects of castration on advanced carcinoma of the prostate gland. Arch surg. 1941; 43(2): 209–23. Publisher Full Text
  • 9.  Glass TR, Tangen CM, Crawford ED, et al.: Metastatic carcinoma of the prostate: identifying prognostic groups using recursive partitioning. J Urol. 2003; 169(1): 164–9. PubMed Abstract | Publisher Full Text
  • 10.  Hong SY, Cho DS, Kim SI, et al.: Prostate-specific antigen nadir and time to prostate-specific antigen nadir following maximal androgen blockade independently predict prognosis in patients with metastatic prostate cancer. Korean J Urol. 2012; 53(9): 607–13. PubMed Abstract | Publisher Full Text | Free Full Text
  • 11.  Hussain M, Tangen CM, Higano C, et al.: Absolute prostate-specific antigen value after androgen deprivation is a strong independent predictor of survival in new metastatic prostate cancer: data from Southwest Oncology Group Trial 9346 (INT-0162). J Clin Oncol. 2006; 24(24): 3984–90. PubMed Abstract | Publisher Full Text
  • 12.  Moher D, Liberati A, Tetzlaff J, et al.: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097. PubMed Abstract | Publisher Full Text | Free Full Text
  • 13.  Wells G, Shea B, O'Connell D, et al.: The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. [cited 2016 May 2]. Reference Source
  • 14.  Miyamoto S, Ito K, Miyakubo M, et al.: Impact of pretreatment factors, biopsy Gleason grade volume indices and post-treatment nadir PSA on overall survival in patients with metastatic prostate cancer treated with step-up hormonal therapy. Prostate Cancer Prostatic Dis. 2012; 15(1): 75–86. PubMed Abstract | Publisher Full Text
  • 15.  Park YH, Hwang IS, Jeong CW, et al.: Prostate specific antigen half-time and prostate specific antigen doubling time as predictors of response to androgen deprivation therapy for metastatic prostate cancer. J Urol. 2009; 181(6): 2520–4; discussion 2525. PubMed Abstract | Publisher Full Text
  • 16.  Nayyar R, Sharma N, Gupta NP: Prognostic factors affecting progression and survival in metastatic prostate cancer. Urol Int. 2010; 84(2): 159–63. PubMed Abstract | Publisher Full Text
  • 17.  Koo KC, Park SU, Kim KH, et al.: Predictors of survival in prostate cancer patients with bone metastasis and extremely high prostate-specific antigen levels. Prostate Int. 2015; 3(1): 10–5. PubMed Abstract | Publisher Full Text | Free Full Text
  • 18.  Kim KH, Han KS, Kim KH, et al.: The prognostic effect of prostate-specific antigen half-life at the first follow-up visit in newly diagnosed metastatic prostate cancer. Urol Oncol. 2015; 33(9): 383.e17–22. PubMed Abstract | Publisher Full Text
  • 19.  Miller JI, Ahmann FR, Drach GW, et al.: The clinical usefulness of serum prostate specific antigen after hormonal therapy of metastatic prostate cancer. J Urol. 1992; 147 (3 Pt 2): 956–61. PubMed Abstract | Publisher Full Text
  • 20.  Tomioka A, Tanaka N, Yoshikawa M, et al.: Nadir PSA level and time to nadir PSA are prognostic factors in patients with metastatic prostate cancer. BMC Urol. 2014; 14: 33. PubMed Abstract | Publisher Full Text | Free Full Text
  • 21.  Teoh JY, Tsu JH, Yuen SK, et al.: Survival outcomes of Chinese metastatic prostate cancer patients following primary androgen deprivation therapy in relation to prostate-specific antigen nadir level. Asia Pac J Clin Oncol. 2017; 13(2): e65–e71. PubMed Abstract | Publisher Full Text
  • 22.  Sasaki T, Onishi T, Hoshina A: Nadir PSA level and time to PSA nadir following primary androgen deprivation therapy are the early survival predictors for prostate cancer patients with bone metastasis. Prostate Cancer Prostatic Dis. 2011; 14(3): 248–52. PubMed Abstract | Publisher Full Text
  • 23.  Kwak C, Jeong SJ, Park MS, et al.: Prognostic significance of the nadir prostate specific antigen level after hormone therapy for prostate cancer. J Urol. 2002; 168(3): 995–1000. PubMed Abstract | Publisher Full Text
  • 24.  Kimura T, Onozawa M, Miyazaki J, et al.: Prognostic impact of young age on stage IV prostate cancer treated with primary androgen deprivation therapy. Int J Urol. 2014; 21(6): 578–83. PubMed Abstract | Publisher Full Text
  • 25.  Bello JO: Predictors of survival outcomes in native sub Saharan black men newly diagnosed with metastatic prostate cancer. BMC Urol. 2017; 17(1): 39. PubMed Abstract | Publisher Full Text | Free Full Text
  • 26.  Teoh JY, Tsu JH, Yuen SK, et al.: Prognostic significance of time to prostate-specific antigen (PSA) nadir and its relationship to survival beyond time to PSA nadir for prostate cancer patients with bone metastases after primary androgen deprivation therapy. Ann Surg Oncol. 2015; 22(4): 1385–91. PubMed Abstract | Publisher Full Text
  • 27.  Mohler J, Antonorakis E, Armstrong A: NCCN Clinical Practice Guideline in Oncology. Prostate Cancer. Version 2.2017. 2017. 2017.
  • 28.  Morote J, Esquena S, Abascal JM, et al.: Usefulness of prostate-specific antigen nadir as predictor of androgen-independent progression of metastatic prostate cancer. Int J Biol Markers. 2005; 20(4): 209–16. PubMed Abstract | Publisher Full Text
  • 29.  Stewart AJ, Scher HI, Chen MH, et al.: Prostate-specific antigen nadir and cancer-specific mortality following hormonal therapy for prostate-specific antigen failure. J Clin Oncol. 2005; 23(27): 6556–60. PubMed Abstract | Publisher Full Text
  • 30.  Keizman D, Huang P, Antonarakis ES, et al.: The change of PSA doubling time and its association with disease progression in patients with biochemically relapsed prostate cancer treated with intermittent androgen deprivation. Prostate. 2011; 71(15): 1608–15. PubMed Abstract | Publisher Full Text | Free Full Text
  • 31.  Chung CS, Chen MH, Cullen J, et al.: Time to prostate-specific antigen nadir after androgen suppression therapy for postoperative or postradiation PSA failure and risk of prostate cancer-specific mortality. Urology. 2008; 71(1): 136–40. PubMed Abstract | Publisher Full Text
  • 32.  Crawford ED, Bennett CL, Andriole GL, et al.: The utility of prostate-specific antigen in the management of advanced prostate cancer. BJU Int. 2013; 112(5): 548–60. PubMed Abstract | Publisher Full Text
  • 33.  Vesely S, Jarolim L, Duskova K, et al.: The use of early postoperative prostate-specific antigen to stratify risk in patients with positive surgical margins after radical prostatectomy. BMC Urol. 2014; 14: 79. PubMed Abstract | Publisher Full Text | Free Full Text
  • 34.  Afriansyah A, Hamid ARAH, Mochtar CA, et al.: Dataset 1 in: Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis. F1000Research. 2018. Data Source
  • 35.  Afriansyah A, Hamid ARAH, Mochtar CA, et al.: Dataset 2 in: Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis. F1000Research. 2018. Data Source
  • 36.  Afriansyah A, Hamid ARAH, Mochtar CA, et al.: Dataset 3 in: Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis. F1000Research. 2018. Data Source

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Afriansyah A, Hamid ARAH, Mochtar CA and Umbas R. Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis [version 1; peer review: 1 approved, 2 approved with reservations]. F1000Research 2018, 7:246 (https://doi.org/10.12688/f1000research.14026.1)
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
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Reviewer Report 21 May 2018
Bannakij Lojanapiwat, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand 
Approved
VIEWS 8
https://doi.org/10.5256/f1000research.15244.r33134
This article demonstrated the importance of PSA kinetic in prognosis of prostate cancer that received ADT.
 
1. One of important PSA kinetic is PSA doubling time; this should be in the analysis if possible.
 
... Continue reading
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Lojanapiwat B. Reviewer Report For: Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis [version 1; peer review: 1 approved, 2 approved with reservations]. F1000Research 2018, 7:246 (https://doi.org/10.5256/f1000research.15244.r33134)
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https://f1000research.com/articles/7-246/v1#referee-response-33134
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Reviewer Report 21 May 2018
Marniza Saad, Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 
Approved with Reservations
VIEWS 9
https://doi.org/10.5256/f1000research.15244.r33670
This article seeks to show correlation between PSA kinetics (initial PSA, PSA nadir, time to nadir) and outcome in patients with metastatic prostate cancer (mPCa) receiving initial treatment with androgen-deprivation therapy (ADT) in terms of survival (PFS, CSS, OS). Seventeen studies ... Continue reading
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Saad M. Reviewer Report For: Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis [version 1; peer review: 1 approved, 2 approved with reservations]. F1000Research 2018, 7:246 (https://doi.org/10.5256/f1000research.15244.r33670)
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https://f1000research.com/articles/7-246/v1#referee-response-33670
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Reviewer Report 15 May 2018
Hong-Jun Li, Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China 
Approved with Reservations
VIEWS 12
https://doi.org/10.5256/f1000research.15244.r34017
In this meta-analysis, the authors analyzed the prognostic value of PSA kinetics in patients with mPCa. They concluded that higher PSA nadir during ADT treatment was associated with shortened progression time and survival. Although the topic was not new, the ... Continue reading
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HOW TO CITE THIS REPORT
Li HJ. Reviewer Report For: Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis [version 1; peer review: 1 approved, 2 approved with reservations]. F1000Research 2018, 7:246 (https://doi.org/10.5256/f1000research.15244.r34017)
The direct URL for this report is:
https://f1000research.com/articles/7-246/v1#referee-response-34017
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Approved
The paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved
Fundamental flaws in the paper seriously undermine the findings and conclusions

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  1. Hong-Jun Li, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
  2. Marniza Saad, University of Malaya, Kuala Lumpur, Malaysia
  3. Bannakij Lojanapiwat, Chiang Mai University, Chiang Mai, Thailand

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    Alongside their report, reviewers assign a status to the article:
    Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
    Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
    Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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