Fankhauser, Christian D; Parry, Matthew G; Ali, Adnan; Cowling, Thomas E; Nossiter, Julie; Sujenthiran, Arun; Berry, Brendan; Morris, Melanie; Aggarwal, Ajay; Payne, Heather; +2 more... van der Meulen, Jan; Clarke, Noel W; (2023) A low prostate specific antigen predicts a worse outcome in high but not in low/intermediate-grade prostate cancer. European journal of cancer, 181. pp. 70-78. ISSN 0959-8049 DOI: https://doi.org/10.1016/j.ejca.2022.12.017
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Abstract
OBJECTIVE: The relationship between prostate-specific antigen (PSA) and prostate cancer (PCa) grade was traditionally thought to be linear but recent reports suggest this is not true in high-grade cancers. We aimed to compare the association between PSA and PCa-specific mortality (PCSM) in clinically localised low/intermediate and high-grade PCa. 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 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 the 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 than PSA 5.1-10 for men treated with EBRT (hazard ratio 1.96 (95% confidence interval 1.15-3.34) or no radical local treatment (hazard ratio 1.99 (95% confidence interval 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 than 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.
Item Type | Article |
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Faculty and Department |
Faculty of Public Health and Policy > Dept of Health Services Research and Policy Faculty of Epidemiology and Population Health |
PubMed ID | 36641896 |
Elements ID | 197900 |
Official URL | http://dx.doi.org/10.1016/j.ejca.2022.12.017 |
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