The U Shape of Prostate-specific Antigen and Prostate Cancer-specific Mortality in High-grade Metastatic Prostate Adenocarcinoma

Jun Wang; Mierxiati Abudurexiti; Ning Shao; Yu Wei; Yao Zhu; Ding-Wei Ye

doi:10.1016/j.euf.2018.08.024

The U Shape of Prostate-specific Antigen and Prostate Cancer-specific Mortality in High-grade Metastatic Prostate Adenocarcinoma

Eur Urol Focus. 2020 Jan 15;6(1):53-62. doi: 10.1016/j.euf.2018.08.024. Epub 2018 Sep 11.

Authors

Jun Wang¹, Mierxiati Abudurexiti¹, Ning Shao¹, Yu Wei¹, Yao Zhu², Ding-Wei Ye³

Affiliations

¹ Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
² Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: yaozhu09@fudan.edu.cn.
³ Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: dwyelie@163.com.

PMID: 30217630
DOI: 10.1016/j.euf.2018.08.024

Abstract

Background: Accumulated evidence suggests that metastatic prostate cancer (mPCa) with a low prostate-specific antigen (PSA) level may be a unique entity. However, its clinical features and prognosis have not been fully evaluated.

Objective: To investigate the clinical features of low-PSA mPCa and the impact of low PSA level on overall survival (OS) and PCa-specific mortality (PCSM) of mPCa.

Design, setting, and participants: A total of 8479 mPCa patients were retrieved from the Surveillance, Epidemiology, and End Results program (2010-2015). The median follow-up was 18 mo.

Outcome measurements and statistical analysis: Cox regression and Fine-Gray competing risk were used to calculate the hazard ratio (HR) and subdistribution hazard ratio (sHR) for OS and PCSM, respectively.

Results and limitations: A higher rate of T4 stage disease (19.8%) and visceral metastasis (18.2%) and the shortest median OS (34 mo) were observed in mPCa patients with Gleason 8-10 and PSA ≤4ng/ml. In the Cox regression model, PSA ≤4ng/ml was a significant predictor of OS for Gleason 8-10 disease. The distribution of PCSM by PSA was U-shaped for Gleason score 8-10 (PSA 4.1-10ng/ml as the referent), with an adjusted sHR of 1.52 for PSA ≤4.0ng/ml (95% confidence interval: 1.17-1.96) versus 0.99 for PSA 10.1-20ng/ml and 1.35 for PSA >20ng/ml. In contrast, the distribution of PCSM by PSA was linear for Gleason 5-7. Sensitivity analyses showed similar results in Gleason 9-10 and Gleason 10 subgroup. The study is limited by its retrospective design.

Conclusions: Low PSA, high-grade mPCa has a higher proportion of T4 stage disease, visceral metastasis, and PCSM.

Patient summary: We found that 2.8% of high-grade metastatic prostate cancer has a prostate-specific antigen level ≤4ng/ml at diagnosis. This population has aggressive clinical features and a poor cancer-specific outcome. Our results highlighted this under-reported population, and the management of these patients warrants further research.

Keywords: Gleason score; Metastatic prostate cancer; Prostate cancer-specific mortality; Prostate-specific antigen.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma / blood*
Adenocarcinoma / mortality*
Adenocarcinoma / pathology
Aged
Humans
Male
Middle Aged
Neoplasm Grading
Prostate-Specific Antigen / blood*
Prostatic Neoplasms / blood*
Prostatic Neoplasms / mortality*
Prostatic Neoplasms / pathology
Retrospective Studies
Survival Rate

Substances

Prostate-Specific Antigen