A low prostate specific antigen predicts a worse outcome in high but not in low/intermediate-grade prostate cancer

医学 前列腺切除术 前列腺癌 危险系数 置信区间 前列腺特异性抗原 泌尿科 比例危险模型 肿瘤科 内科学 前列腺 近距离放射治疗 放射治疗 癌症
作者
Christian Daniel Fankhauser,Matthew G. Parry,Adnan Ali,Thomas E Cowling,Julie Nossiter,Arun Sujenthiran,Brendan Berry,Melvin L. Morris,Ajay Aggarwal,Heather Payne,Jan van der Meulen,Noel W. Clarke
出处
期刊:European Journal of Cancer [Elsevier BV]
卷期号:181: 70-78 被引量:3
标识
DOI:10.1016/j.ejca.2022.12.017
摘要

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.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.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.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.
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