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. 2023 Nov;83(15):1504-1515.
doi: 10.1002/pros.24609. Epub 2023 Aug 7.

Survival outcomes of patients treated with local therapy for nonmetastatic prostate cancer with high prostate-specific antigen concentrations

Aleksander Ślusarczyk  1 , Michael Baboudjian  2 , Piotr Zapała  1 , Takafumi Yanagisawa  3   4 , Marcin Miszczyk  5 , Marcin Chlosta  3   6 , Paul Krumpoeck  3 , Marco Moschini  7 , Giorgio Gandaglia  7 , Guillaume Ploussard  8 , Juan G Rivas  9 , Marcin Życzkowski  10 , Pierre I Karakiewicz  11 , Piotr Radziszewski  1 , Michael S Leapman  12 , Shahrokh F Shariat  3   13   14   15   16   17   18 , Paweł Rajwa  3   10
Affiliations

Survival outcomes of patients treated with local therapy for nonmetastatic prostate cancer with high prostate-specific antigen concentrations

Aleksander Ślusarczyk et al. Prostate. 2023 Nov.

Abstract

Background: Patients with nonmetastatic prostate cancer (nmPCa) and high prostate-specific antigen (PSA) levels due to the high likelihood of metastasis pose a clinical dilemma regarding their optimal treatment and long-term outcomes after initial local therapy. We aimed to evaluate the oncologic outcomes of patients treated with radical prostatectomy (RP) or radiotherapy (RT) for nmPCa with high PSA levels.

Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with nmPCa who received RP or RT from 2004 through 2015. We included nmPCa patients with high PSA levels categorized as ≥50 and ≥98 ng/mL, the highest level recorded in SEER. We used the Kaplan-Meier method and Cox proportional hazards to analyze cancer-specific (CSS) and overall survival (OS).

Results: We included 6177 patients with nmPCa and PSA ≥ 50 ng/mL at diagnosis; 1698 (27%) had PSA ≥ 98 ng/mL. Of these, 1658 (26.8%) underwent RP and 4519 (73.16%) patients received primary RT. Within a median of 113 months (interquartile range 74-150 months), the 5- and 10-year CSS estimates were 92.3% and 81.5% respectively; 10-year OS was 61%. In the PSA ≥ 98 ng/mL subgroup 5- and 10-year CSS estimates were 89.2% and 76%, respectively. In multivariable analyses for CSS, ISUP grade group (p < 0.001), N stage (p < 0.001), treatment with RP (hazard ratio [HR] = 0.60, 95% confidence interval [CI] 0.43-0.83, p < 0.001), and patient's age (p < 0.05) were associated with improved CSS. In the whole cohort of patients with PSA ≥ 50 ng/mL and RP subgroup, PSA failed to retain its independent prognostic value for CSS.

Conclusions: Patients treated with local therapy for nmPCa with very high PSA at diagnosis have relatively good long-term oncological outcomes. Therefore, among well-selected patients with nmPCa, high PSA levels alone should not preclude the use of radical local therapy. Potential selection bias limits inferences about the relative effectiveness of specific local therapies in this setting.

Keywords: high PSA; nonmetastatic prostate cancer; prostate-specific antigen; radical prostatectomy; radiotherapy; survival.

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References

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