The U Shape of Prostate-specific Antigen and Prostate Cancer-specific Mortality in High-grade Metastatic Prostate Adenocarcinoma.
Gleason score
Metastatic prostate cancer
Prostate cancer-specific mortality
Prostate-specific antigen
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
15 01 2020
15 01 2020
Historique:
received:
18
06
2018
revised:
25
07
2018
accepted:
28
08
2018
pubmed:
16
9
2018
medline:
21
5
2021
entrez:
16
9
2018
Statut:
ppublish
Résumé
Accumulated evidence suggests that metastatic prostate cancer (mPCa) with a low prostate-specific antigen (PSA) level may be a unique entity. However, its clinical features and prognosis have not been fully evaluated. To investigate the clinical features of low-PSA mPCa and the impact of low PSA level on overall survival (OS) and PCa-specific mortality (PCSM) of mPCa. A total of 8479 mPCa patients were retrieved from the Surveillance, Epidemiology, and End Results program (2010-2015). The median follow-up was 18 mo. Cox regression and Fine-Gray competing risk were used to calculate the hazard ratio (HR) and subdistribution hazard ratio (sHR) for OS and PCSM, respectively. A higher rate of T4 stage disease (19.8%) and visceral metastasis (18.2%) and the shortest median OS (34 mo) were observed in mPCa patients with Gleason 8-10 and PSA ≤4ng/ml. In the Cox regression model, PSA ≤4ng/ml was a significant predictor of OS for Gleason 8-10 disease. The distribution of PCSM by PSA was U-shaped for Gleason score 8-10 (PSA 4.1-10ng/ml as the referent), with an adjusted sHR of 1.52 for PSA ≤4.0ng/ml (95% confidence interval: 1.17-1.96) versus 0.99 for PSA 10.1-20ng/ml and 1.35 for PSA >20ng/ml. In contrast, the distribution of PCSM by PSA was linear for Gleason 5-7. Sensitivity analyses showed similar results in Gleason 9-10 and Gleason 10 subgroup. The study is limited by its retrospective design. Low PSA, high-grade mPCa has a higher proportion of T4 stage disease, visceral metastasis, and PCSM. We found that 2.8% of high-grade metastatic prostate cancer has a prostate-specific antigen level ≤4ng/ml at diagnosis. This population has aggressive clinical features and a poor cancer-specific outcome. Our results highlighted this under-reported population, and the management of these patients warrants further research.
Sections du résumé
BACKGROUND
Accumulated evidence suggests that metastatic prostate cancer (mPCa) with a low prostate-specific antigen (PSA) level may be a unique entity. However, its clinical features and prognosis have not been fully evaluated.
OBJECTIVE
To investigate the clinical features of low-PSA mPCa and the impact of low PSA level on overall survival (OS) and PCa-specific mortality (PCSM) of mPCa.
DESIGN, SETTING, AND PARTICIPANTS
A total of 8479 mPCa patients were retrieved from the Surveillance, Epidemiology, and End Results program (2010-2015). The median follow-up was 18 mo.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Cox regression and Fine-Gray competing risk were used to calculate the hazard ratio (HR) and subdistribution hazard ratio (sHR) for OS and PCSM, respectively.
RESULTS AND LIMITATIONS
A higher rate of T4 stage disease (19.8%) and visceral metastasis (18.2%) and the shortest median OS (34 mo) were observed in mPCa patients with Gleason 8-10 and PSA ≤4ng/ml. In the Cox regression model, PSA ≤4ng/ml was a significant predictor of OS for Gleason 8-10 disease. The distribution of PCSM by PSA was U-shaped for Gleason score 8-10 (PSA 4.1-10ng/ml as the referent), with an adjusted sHR of 1.52 for PSA ≤4.0ng/ml (95% confidence interval: 1.17-1.96) versus 0.99 for PSA 10.1-20ng/ml and 1.35 for PSA >20ng/ml. In contrast, the distribution of PCSM by PSA was linear for Gleason 5-7. Sensitivity analyses showed similar results in Gleason 9-10 and Gleason 10 subgroup. The study is limited by its retrospective design.
CONCLUSIONS
Low PSA, high-grade mPCa has a higher proportion of T4 stage disease, visceral metastasis, and PCSM.
PATIENT SUMMARY
We found that 2.8% of high-grade metastatic prostate cancer has a prostate-specific antigen level ≤4ng/ml at diagnosis. This population has aggressive clinical features and a poor cancer-specific outcome. Our results highlighted this under-reported population, and the management of these patients warrants further research.
Identifiants
pubmed: 30217630
pii: S2405-4569(18)30243-8
doi: 10.1016/j.euf.2018.08.024
pii:
doi:
Substances chimiques
Prostate-Specific Antigen
EC 3.4.21.77
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
53-62Informations de copyright
Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.