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Association of very low prostate‐specific antigen levels with increased cancer‐specific death in men with high‐grade prostate cancer
Author(s) -
Mahal Brandon A.,
Aizer Ayal A.,
Efstathiou Jason A.,
Nguyen Paul L.
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29691
Subject(s) - medicine , prostate cancer , prostate specific antigen , hazard ratio , confidence interval , urology , prostate , gynecology , cancer , oncology
BACKGROUND The objective of this study was to determine whether a very low presenting prostate‐specific antigen (PSA) level was associated with greater prostate cancer–specific mortality (PCSM) among men with a Gleason score (GS) of 8 to 10. METHODS The Surveillance, Epidemiology, and End Results program was used to identify 328,904 men diagnosed with clinicalT1 (cT1)‐4N0M0 prostate cancer between 2004 and 2010. A multivariate Fine‐Gray competing risks regression analysis was used to determine PCSM as a function of the PSA level (≤2.5, 2.6‐4, 4.1‐10, 10.1‐20, 20.1‐40, or > 40 ng/mL) and GS (8‐10 vs ≤ 7). RESULTS The median follow‐up was 38 months. Among men with GS 8‐10 disease, with a PSA level of 4.1 to 10 ng/mL as the referent, the adjusted hazard ratio for PCSM for men was 2.15 with a PSA level ≤ 2.5 ng/mL (95% confidence interval [CI], 1.65‐2.79; P < .001), 1.60 with a PSA level of 2.6 to 4 ng/mL (95% CI, 1.22‐2.10; P = .001), 1.60 with a PSA level of 10.1 to 20 ng/mL (95% CI, 1.41‐1.82; P < .001), 2.08 with a PSA level of 20.1 to 40 ng/mL (95% CI, 1.81‐2.38; P < .001), and 3.23 with a PSA level > 40 ng/mL (95% CI, 2.85‐3.65; P < .001). This suggested a U‐shaped distribution. There was a significant interaction between the PSA level and GS ( P interaction < .001) such that only a PSA level ≤ 2.5 ng/mL significantly predicted poorer PCSM among patients with GS 8‐10 disease. CONCLUSIONS Among patients with high‐grade disease, patients with PSA levels ≤ 2.5 ng/mL or PSA levels of 2.6 to 4 ng/mL appear to have a higher risk for cancer‐specific death in comparison with patients with PSA levels of 10.1 to 20 ng/mL, and this supports the notion that low PSA levels in GS 8‐10 disease may be a sign of aggressive and very poorly differentiated or anaplastic low PSA–producing tumors. Patients with low‐PSA, GS 8‐10 disease should be considered for clinical trials studying the use of chemotherapy and other novel agents for very high‐risk prostate cancers. Cancer 2016;122:78–83. © 2015 American Cancer Society .