A Low PSA Predicts a Worse Outcome in High but Not in Low/Intermediate Grade Prostate Cancer
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 (RP) 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 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 compared to PSA 5.1-10 for men treated with EBRT (Hazard ratio (HR) 1.96 (95% Confidence interval (CI) 1.15-3.34) or no radical local treatment (HR 1.99 (95% CI 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 compared to 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.
Christian D. Fankhauser, Matthew G. Parry, Adnan Ali, Thomas E. Cowling, Julie Nossiter, Arun Sujenthiran, Brendan Berry, Melanie Morris, Ajay Aggarwal, Heather Payne, Jan van der Meulen, Noel W. Clarke
Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; University of Zurich, Zurich, Switzerland; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University; GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom; Department of Radiotherapy, Guy’s and St Thomas’ NHS Foundation Trust; Dept of Clinical Oncology University College London Hospital NHS Trust, London, United Kingdom; Department of Urology, Salford Royal NHS Foundation Trust, Manchester, UK
Source: Fankhauser C., Parry M., Ali A., et al. A low PSA predicts a worse outcome in high but not in low/intermediate grade prostate cancer. European Journal of Cancer. 2022. ISSN 0959-8049.