Localized prostate cancer: very high PSA tied to worse oncologic outcomes

  • Tilki D & al.
  • Urol Oncol
  • 27 Jan 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Initial very high PSA levels are associated with a higher risk for biochemical recurrence (BCR), metastatic progression, and cancer-specific mortality (CSM) in patients with localized prostate cancer undergoing radical prostatectomy.

Why this matters

  • Very high risk patients with potentially undetected metastases may benefit from multimodal treatment strategies including local treatment.

Study design

  • 2811 patients with clinically localized prostate cancer and initial PSA ≥20 ng/mL underwent radical prostatectomy.
  • Funding: No external funding.

Key results

  • 16.2% and 5.8% of patients had a PSA of 50-99.9 and ≥100 ng/mL, respectively.
  • Median follow-up, 47.5 months.
  • At 10 years, patients with PSA 20-49.9, 50-99.9, and ≥100 ng/mL showed a significant difference in:
    • BCR-free survival rates: 46.9%, 32.1%, and 29.0%, respectively (P<.001>
    • Metastasis-free survival rates: 78.4%, 67.2%, and 37.3%, respectively (P<.001>
    • CSS rates: 93.7%, 85.5%, and 66.7%, respectively (P<.001>
  • PSA 50-99.9 and ≥100 ng/mL were independent predictors of
    • BCR: HR, 1.3 (P<.001 and respectively.>
    • Metastatic progression: HR, 1.4 (P=.04) and 2.3 (P<.001 respectively.>
    • CSM: HR, 1.9 (P<.01 and respectively.>

Limitations

  • Retrospective design.