This retrospective cohort study evaluated PCa patients undergoing radical prostatectomy (RP) from 1994-2015 at Walter Reed National Military Medical Center. Whole-mounted prostatectomy specimens were classified using 2014 ISUP Gleason grading system. Excluding the diagnostic PSA, screening history was categorized as: ≥ 6 PSA’s prior to PCa diagnosis (uppermost quartile), 1-5 (lower 3 quartiles), vs. no screening history. Multivariable logistic regression (MLR) was used to examine NCCN risk stratum (intermediate-high vs. low) and Gleason upgrade from biopsy to RP. Multivariable models controlled for age at RP, race, family history and obesity (BMI > 30 vs. ≤ 30 kg/m2).
There were 1,772 eligible patients with a median follow-up and age at RP of 7.0 and 59.8 years, respectively. Prior to PCa diagnosis, 42% and 19% of men had 1-5 and ≥ 6 PSA’s screenings, respectively. MLR showed greater odds of intermediate or high vs. low risk disease for PSA screening history of none vs. 1-5 (OR = 1.33, CI = 1.03-1.70, p = 0.028) but not for none vs. ≥ 6 (p = 0.44). MLR showed increased odds of Gleason upgrade for none vs. ≥ 6 (OR = 1.81, CI = 1.23-2.7, p < 0.001). Multivariable Cox PH models showed incrementally poorer BCR-free survival as screening history decreased (HR None vs. ≥6 = 2.27, CI = 1.54-3.33, p < 0.001; HR None vs. 1-5= 1.49, CI = 1.15-1.92, p = 0.002).
In summary, higher risk stratum, increased Gleason upgrade, and poorer BCR-free survival were associated with no PSA screening history. BCR-free survival was incrementally worsened by less PSA screening. A complete absence of PSA screening may lead to more aggressive disease at presentation and poorer clinical outcomes.
Presented By: Thomas Gerald, MD, Walter Reed National Military Medical Center, Bethesda, MD
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
at the 2017 ASCO Annual Meeting - June 2 - 6, 2017 - Chicago, Illinois, USA