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Intermediate End Point for Prostate Cancer Mortality

Whether the prostate-specific antigen (PSA) response to salvage hormonal therapy can act as an intermediate end point for prostate cancer–specific mortality (PCSM) remains unclear. D’Amico et al. (p. 509) evaluated whether PSA response—the ratio of the rate of PSA change after salvage hormonal therapy to the rate of PSA change before salvage therapy—is associated with PCSM by using data from a single institution and two pooled multi-institutional databases. They found that PSA response was statistically significantly associated with time to PCSM following salvage hormonal therapy; however, its constituents (i.e., pre–hormonal and post–hormonal PSA slopes) were not. They also found that patients with a PSA response less than or equal to 1 had a shorter time to PCSM than patients with a PSA response of more than 1. The authors conclude that PSA response to salvage hormonal therapy can serve as an intermediate end point for PCSM in patients with a rising PSA level following surgery or radiation therapy.