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Prognosis of prostate cancer with initial prostate-specific antigen >1,000 ng/mL at diagnosis

Authors Kan HC, Hou CP, Lin YH, Tsui KH, Chang PL, Chen CL

Received 10 February 2017

Accepted for publication 13 May 2017

Published 12 June 2017 Volume 2017:10 Pages 2943—2949

DOI https://doi.org/10.2147/OTT.S134411

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 3

Editor who approved publication: Dr Yao Dai

Hung-Cheng Kan,1 Chen-Pang Hou,1,2 Yu-Hsiang Lin,1,2 Ke-Hung Tsui,1,2 Phei-Lang Chang,1,2 Chien-Lun Chen1,2

1Department of Urology, Chang Gung Memorial Hospital, 2School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China

Purpose: Prostate cancer patients with surprisingly high prostate-specific antigen (PSA) are encountered clinically. However, descriptions of this group of patients are extremely rare in the published literature. This study reports treatment outcome and long-term prognosis for this group of patients.
Patients and methods: Between January 2007 and December 2012, 2,064 patients with PCa diagnosed at a tertiary medical center were retrospectively reviewed. A total of 90 PCa cases were identified with initial PSA (iPSA) >1,000 ng/mL at diagnosis. A retrospective study was conducted in this cohort, with comparison among stratified patient age groups, PSA, treatment options, and overall survival.
Results: The mean PSA at PCa diagnosis in this cohort was 3,323 ng/mL (1,003–23,126, median: 2,050 ng/mL). Most patients were in the age group 65–79 years (55/90, 61%). Males older than 80 years had a poor prognosis (P<0.001). Forty-six patients (51%) underwent orchiectomy with a median follow-up period of 16.2 (1.3–72.7) months, compared to 44 patients treated with medical castration and a median follow-up of 9.1 (0.3–70.5) months. Kaplan–Meier analysis revealed survival benefit from treatment with orchiectomy (P<0.001). PSA reduction >90% of iPSA following primary androgen deprivation therapy (reaching true nadir) could be a predictor of longer survival (P<0.001). Cox regression revealed the hazard ratio (HR) of variables were age (HR: 4.57, 95% confidence interval [CI]: 1.45–14.37, P=0.009), reaching true nadir (HR: 0.12, 95% CI: 0.03–0.58, P=0.008), and the treatment option with orchiectomy (HR: 0.22, 95% CI: 0.65–0.76, P=0.016).
Conclusion: Age ≥80 years indicated poor overall survival in PCa patients with iPSA >1,000 ng/mL. Reaching a true nadir of PSA following primary androgen deprivation therapy could be a predictor of longer survival. Bilateral orchiectomy is recommended for this group of patients.

Keywords:
prostate cancer, PSA, nadir, androgen deprivation, orchiectomy

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