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. 2017 Sep 8;9(1):428-441.
doi: 10.18632/oncotarget.20787. eCollection 2018 Jan 2.

Comparison of clinical and survival characteristics between prostate cancer patients of PSA-based screening and clinical diagnosis in China

Libo Xu  1 , Jinguo Wang  2 , Baofeng Guo  3 , Haixia Zhang  4 , Kaichen Wang  3 , Ding Wang  1 , Chang Dai  5 , Ling Zhang  1 , Xuejian Zhao  1
Affiliations

Comparison of clinical and survival characteristics between prostate cancer patients of PSA-based screening and clinical diagnosis in China

Libo Xu et al. Oncotarget. .

Abstract

Prostate-specific antigen (PSA)-based mass screening remains the most controversial topic in prostate cancer. PSA-based mass screening has not been widely used in China yet. The aim of our study was to evaluate the effect of the PSA-based screening in China. The cohort consisted of 1,012 prostate cancer patients. Data were retrospectively collected and clinical characteristics of the cohorts were investigated. Survival was analyzed for prostatic carcinoma of both PSA screened and clinically diagnosed patients according to clinical characteristics and the National Comprehensive Cancer Network (NCCN) risk classification. Cox Proportional Hazards Model analysis was done for risk predictor identification. The median age was 71 years old. Five-year overall and prostate-cancer-specific survival in prostatic adenocarcinoma patients were 77.52% and 79.65%; 10-year survivals were 62.57% and 68.60%, respectively. Survival was significantly poorer in patients with metastases and non-curative management. T staging and Gleason score by NCCN classification effectively stratified prostatic adenocarcinoma patients into different risk groups. T staging was a significant predictor of survival by COX Proportional Hazard Model. PSA screened patients had a significantly higher percentage diagnosed in early stage. PSA screened prostatic adenocarcinoma patients had a better prognosis in both overall and prostate cancer-specific survivals. This Chinese cohort had a lower overall and prostate cancer survival rate than it is reported in western countries. The incidence of early-stage prostate cancer found in PSA-based mass screening was high and there were significant differences in both overall and prostate cancer-specific survival between the PSA-screened and clinically diagnosed patients.

Keywords: PSA-based mass screening; metastases; overall survival; prostate cancer; prostate-cancer specific mortality.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors have no conflicts of interest to declare regarding the manuscript.

Figures

Figure 1
Figure 1. Overall and prostate cancer-specific survivals based on median age, metastatic status and management approach
(a) Comparison of overall and prostate cancer-specific survival for the whole cohort, P=0.0409. (b, c) Overall and prostate cancer-specific survival comparison for men between age 71 or less and age>71. (d, e) Overall and prostate cancer-specific survival comparision for men with/without metastases. (f, g) Overall and prostate cancer-specific survival comparision based on management approach.
Figure 2
Figure 2. Overall survival and prostate cancer specific-survival according to each NCCN classification related factor PSA, T stage and Gleason score as well as NCCN risk categories
(a, b) Overall and prostate cancer-specific survival comparison among patients with PSA<10, 10≤PSA≤20 and PSA>20. (c, d) Overall and prostate cancer-specific survival comparison among subcategories of patients with T1-T2a, T2b-T2c and T3-T4. (e, f) Overall and prostate cancer-specific survival comparison among patients with Gleason≤6, Gleason 7 and Gleason≥8. (g, h) Overall and prostate cancer-specific survival comparision based on the NCCN classification.
Figure 3
Figure 3. Clinical characteristics and survivals in PSA screened, PSA screened with later diagnosis and clinically diagnosed prostatic adenocarcinoma patients
(a) T staging distribution. (b) Distribution of N staging. (c) Distribution of M staging. (d) Gleason score distribution. (e) Management approach comparison among three subcategories (P<0.0001). *P<0.05; **P<0.01.
Figure 4
Figure 4. Overall and prostate cancer-specific survival comparison among PSA screened, PSA screened with later diagnosis and clinically diagnosed patients
(a, b) Overall and prostate cancer-specific survival comparison among PSA screened, PSA screened with later diagnosis and clinically diagnosed patients. (c, d) Overall and prostate cancer-specific survival comparison between PSA screened and clinical diagnosed patients. (e, f) Overall and prostate cancer-specific survival comparison between PSA screened patients and PSA screened with later diagnosis. (g, h) Overall and prostate cancer-specific survival comparison between PSA screened with later diagnosed and clinically diagnosed patients.
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