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Outcomes in patients with Gleason score 8–10 prostate cancer: relation to preoperative PSA level
Author(s) -
McGuire Barry B.,
Helfand Brian T.,
Loeb Stacy,
Hu Qiaoyan,
O'Brien Daniel,
Cooper Phillip,
Yang Ximing,
Catalona William J.
Publication year - 2012
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2011.10628.x
Subject(s) - medicine , prostate cancer , prostatectomy , urology , prostate specific antigen , prostate , cancer , oncology
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? High‐grade prostate cancers are associated with poor disease‐specific outcomes. A proportion of these tumours produce little PSA. This study demonstrates that among Gleason 8–10 prostate cancers, some of the worst survival outcomes are associated with the lowest PSA levels. OBJECTIVE• To assess outcomes of patients with Gleason score 8–10 prostate cancer (CaP) with a low (≤2.5 ng/mL) vs higher preoperative serum PSA levels.PATIENTS AND METHODS• From 1983 to 2003, 5544 patients underwent open radical prostatectomy, of whom 354 had a Gleason 8–10 tumour in the prostatectomy specimen. • Patients were stratified according to preoperative PSA level into four strata: ≤2.5 ng/mL ( n = 31), 2.6–4 ng/mL ( n = 31), 4.1–10 ng/mL ( n = 174), and >10 ng/mL ( n = 118). • We compared biochemical progression‐free survival (PFS), metastasis‐free survival (MFS), and cancer‐specific survival (CSS) as a function of preoperative PSA level.RESULTS• Patients with PSA level ≤2.5 ng/mL were more likely to have seminal vesicle invasion ( P = 0.003). • On Kaplan–Meier survival analysis, patients with a PSA level ≤2.5 ng/mL had proportionately worse outcomes than their counterparts with higher PSA levels. • The 7‐year PFS in the PSA ≤2.5 ng/mL stratum was lower than those of the PSA 2.6–4 ng/mL and 4–10 ng/mL strata (36% vs 50 and 42%, respectively); however, the lowest 7‐year PFS was found in those with a PSA level >10 ng/mL (32%, P = 0.02). • Gleason score 8–10 tumours with a PSA level ≤2.5 ng/mL also tended to have the lowest 7‐year MFS (75, 93, 89 and 92% for PSA level ≤2.5, 2.6–4, 4.1–10 and >10 ng/mL, respectively, P = 0.2) and CSS (81, 100, 94 and 90% for PSA level ≤2.5, 2.6–4, 4.1–10 and >10 ng/mL, respectively, P = 0.3), although these differences were not statistically significant. • In the subset with palpable disease, Gleason grade 8–10 disease with PSA level ≤2.5 ng/mL also was associated with a worse prognosis.CONCLUSIONS• In patients with Gleason grade 8–10 disease, a proportion of these tumours are so poorly differentiated that they produce relatively little PSA. • Patients with high‐grade, low‐PSA tumours had less favourable outcomes than many of those with higher PSA levels.