A low prostate specific antigen predicts a worse outcome in high but not in low/intermediate-grade prostate cancer
Fankhauser, Christian D Parry, M. G. Ali, Adnan Cowling, T. E. Nossiter, J. Sujenthiran, A. Berry, B. Morris, M. Aggarwal, A. Payne, H.
Fankhauser, Christian D
Parry, M. G.
Ali, Adnan
Cowling, T. E.
Nossiter, J.
Sujenthiran, A.
Berry, B.
Morris, M.
Aggarwal, A.
Payne, H.
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Abstract
Objective: The relationship between prostate-specific antigen (PSA) and prostate cancer (PCa) grade was traditionally thought to be linear but recent reports suggest this is not true in high-grade cancers. We aimed to compare the association between PSA and PCa-specific mortality (PCSM) in clinically localised low/intermediate and high-grade PCa.
Subjects/patients and methods: Retrospective cohort study using the National Prostate Cancer Audit database in England of men treated with external beam radiotherapy (EBRT), EBRT and brachytherapy boost (EBRT + BT), radical prostatectomy or no radical local treatment between 2014 and 2018. Multivariable competing-risk regression was used to examine the association between PSA, Gleason, and PCSM. Multivariable restricted cubic spline regression was used to explore the non-linear associations of PSA and PCSM.
Results: 102,089 men were included, of whom 71,138 had low/intermediate-grade and 22,425 had high-grade PCa. In high-grade, 4-year PCSM was higher with PSA ≤5 than PSA 5.1-10 for men treated with EBRT (hazard ratio 1.96 (95% confidence interval 1.15-3.34) or no radical local treatment (hazard ratio 1.99 (95% confidence interval 1.33-2.98). Restricted cubic spline regression showed that PSA and PCSM have a non-linear association in high-grade but a linear association in low/intermediate-grade PCa.
Conclusion: The low-PSA/high-grade combination in M0 PCa treated with EBRT has a higher PCSM than those with high-grade and intermediate PSA levels. In high-grade disease, the PSA association was non-linear; by contrast, low/intermediate-grade had a linear relationship. This confirms a more aggressive biology in low PSA secreting high-grade PCa and a worse outcome following treatment.
Description
Date
2022
Publisher
Collections
Keywords
Type
Article
Citation
Fankhauser CD, Parry MG, Ali A, Cowling TE, Nossiter J, Sujenthiran A, et al. A low prostate specific antigen predicts a worse outcome in high but not in low/intermediate-grade prostate cancer. European journal of cancer (Oxford, England : 1990). 2022 Dec 26;181:70-8. PubMed PMID: 36641896. Epub 2023/01/16. eng.