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
Hi,
My father was diagnosed with Prostate cancer after cystoscopy. Obstruction was removed, Gleason Score was 9 and PSA was 8 at that time. PET Scan shown that Cancer cells are spreading outside the prostate but it was minor.
Dr. said that because Gleason Score is high but PSA ia 8 so it looks like it is more aggressive.He asked to start Harmon therapy and Radio therapy.
According to the schedule he said that after 3 months of 1st injection, my father need to be in the 20 radio therapy sessions and then another injection. This treatment will continue every 3 months for 5 years and he should take the medicines continuously.
This is now about to complete 3rd month after 1st injection. he is taking medicines continuously and in next 10 days he need to take 2nd injection with Radio therapy.
In last 3 months my father was also under the Ayurveda treatment, right now his PSA score is 2.2. According to Ayurveda Dr. condition looks like in control and he is suggesting a bone scan so that current condition could be scanned.
My father is in the impression that his cancer is getting cured with the Ayurveda. He don’t want to be in the Radio therapy.
As per my discussion with Dr. if Gleason score is high but PSA is near 8 or decreasing, then its more aggressive.
According to my father, he is feeling cured as the issues he was facing before Ayurveda treatment are not now.
I am forcing him to get checkup with his Dr who suggested him Harmon therapy, so that he can tell us more about the condition. But my father is afraid that he will ask for Radio therapy and which my make the cancer incurable.
Please suggest ….
Thanks in advance
Challenging situation. Lots of reasons why folks get hormone +/- radiation therapy for prostate cancer. Please make sure that you and your father have a full and informed conversation with his doctors about optimal care. Good luck!
SAK
Steven A. Kaplan, M.D.
Professor of Urology
Icahn School of Medicine at Mount Sinai
Director, Benign Urologic Diseases and The Men’s Health Program
Mount Sinai Health System