DYNAMIC ANDROGEN RESPONSE INDEX AND ITS ASSOCIATION WITH BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY FOLLOWING NEOADJUVANT ANDROGEN DEPRIVATION THERAPY.

Abstract

Background: Neoadjuvant androgen deprivation therapy (NADT) before radical prostatectomy (RP) remains controversial in the management of localized and locally advanced prostate cancer. A major limitation of this strategy is the lack of biomarkers capable of identifying tumors biologically sensitive to androgen deprivation. This study aimed to evaluate the prognostic value of a dynamic androgen response index (IAR) and develop a predictive model for biochemical recurrence (BCR) after RP.

Materials and methods: The retrospective single-center study included 84 patients with prostate cancer treated with NADT followed by RP. The IAR was defined as the ratio between logarithmic slopes of PSA and testosterone decline during neoadjuvant therapy. Cox regression analysis was performed to identify predictors of BCR. A predictive model and nomogram were constructed based on independent predictors. Model performance was evaluated using ROC analysis, calibration plots, and decision curve analysis.

Results: During a median follow-up of 56 months, BCR occurred in 62 patients. Clinical stage ≥ cT3a (HR 2.34; p = 0.003) and IAR (HR 1.48; p = 0.024) were independent predictors of BCR. The model demonstrated moderate discrimination (AUC 0.68) and satisfactory calibration.

Conclusions: The IAR may reflect the biological responsiveness of prostate cancer to androgen deprivation. These findings should be considered hypothesis-generating and require further validation in the context of risk stratification for BCR following RP after NADT.