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Posted by on Aug 13, 2016 in Prostate cancer | 2 comments

In a nutshell

This study examined health outcomes based on PSA (prostate specific antigen) levels in men with high-grade disease. Authors reported more aggressive cancers with low PSA compared to medium PSA. Low PSA appeared to progress similarly to high PSA in men with high-grade disease.

Some background

Prostate cancer is often graded based on how aggressive the cancer is (Gleason score). The higher the Gleason score, the more likely the cancer is to grow and spread. This is known as high-grade disease. PSA (prostate specific antigen) is a protein elevated in the blood in prostate cancer. PSA levels are commonly used to monitor and calculate disease status. An increase in PSA levels is a usually a risk factor associated with disease progression.

It has been suggested, however, that men with high-grade disease but a low PSA level may have the most aggressive form of prostate cancer. More studies are needed to examine this link. Identifying the risk of progression early can help in appropriate treatment selection.

Methods & findings

The aim of this study was to examine health outcomes across different PSA levels in men with high-grade disease.

The records of 37,283 men with prostate cancer were included in this analysis. All men had high-grade disease (Gleason score of 8 to 10). Men were divided according to PSA levels at diagnosis: low (0.1 to 3.9 ng/ml), medium (4 to 9.9 ng/ml), high (10 to 19.9 ng/ml), and very high (20 ng/ml or more). Patients were followed for an average of 74 months.

Compared to men with medium PSA levels, men with low PSA levels were significantly more likely to present with a late tumor stage (of 3 or 4), cancer spread to local lymph nodes, and cancer spread to distant parts of the body (metastasis). However, among men treated with prostate surgery, lower PSA levels were not at associated with more advanced disease or cancer spread. Overall, men with very high PSA levels had the highest rate of metastatic disease (27%) compared to all other PSA groups (3 to 8%).

The best overall survival rate (proportion who have not died from any cause since treatment) was observed in men with medium PSA levels. Overall survival rate was similar between men with low and high PSA levels, and was worst for men with very high PSA levels.

 

Among men treated with prostate surgery, the 6-year overall survival rate was significantly lower with low PSA levels (89.1%) compared to medium PSA levels (91%). Similarly, among men treated with radiation therapy, the 6-year overall survival rate was significantly lower with  low PSA levels (75.8%) than with medium PSA levels (81%).

The bottom line

Authors concluded that men with high-grade disease and low PSA levels present with more aggressive cancers compared to men with medium PSA levels. While very high PSA was associated with the worst outcomes, low PSA appeared to progress similarly to high PSA.

 
Published By :

Urologic oncology

Date :

Oct 29, 2015

Original Title :

Stage at presentation and survival outcomes of patients with Gleason 8-10 prostate cancer and low prostate-specific antigen.

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