Higher Persistent PSA Level: A Bad Omen?

TOPLINE:

Higher persistent PSA ranges submit-surgical treatment had been linked to increased mortality possibility, with 8-twelve months prostate cancer–particular mortality reaching 13.86% for a prostate-particular antigen (PSA) ≥ 1 ng/mL.

METHODOLOGY:

• The veteran 1.5-month to 2.0-month time interval following radical prostatectomy (RP) for assessing persistent PSA remained questionable for accuracy.
• Analysis incorporated 43,298 patients with scientific stage T1N0M0 to T3N0M0 prostate cancer handled with RP between 1992 and 2020 at two academic centers, with apply-up records unexcited till November 2023.
• Researchers evaluated whether or now not a vital interplay existed between pre-RP PSA level (> 20 ng/mL vs ≤ 20 ng/mL) and power vs undetectable PSA after RP on mortality possibility, adjusting for identified prognostic factors.
• Investigators assessed the affect of increasing persistent PSA ranges on prostate cancer–particular mortality and all-reason mortality possibility, with a median apply-up of 6.23 years.
• Patients with PSA > 20 ng/mL or Gleason score 8-10 underwent CT or MRI and bone scan sooner than surgical treatment.

TAKEAWAY:

• Among patients with persistent PSA, these with pre-RP PSA > 20 ng/mL showed considerably lowered all-reason mortality possibility (adjusted hazard ratio [aHR], 0.69; 95% CI, 0.51-0.91; P = .01) and prostate cancer–particular mortality possibility (aHR, 0.41; 95% CI, 0.25-0.66; P < .001).
• Increasing persistent PSA ranges had been associated to higher all-reason mortality possibility (aHR, 1.14; 95% CI, 1.04-1.24; P = .004) and prostate cancer–particular mortality possibility (aHR, 1.27; 95% CI, 1.12-1.Forty five; P < .001).
• Post-RP radiation therapy considerably lowered prostate cancer–particular mortality possibility only in patients with persistent PSA (aHR, 0.54; 95% CI, 0.33-0.87; P = .01).
• Eight-twelve months prostate cancer–particular mortality estimates had been 13.86% (95% CI, 10.47-18.22) for persistent PSA ≥ 1 ng/mL vs 8.17% (95% CI, 6.08-10.93) for < 1 ng/mL.

IN PRACTICE:

“PSA level assessed for a minimal of 3 months after RP might presumably well presumably also simply lower overtreatment, and in this leer, the next persistent PSA level changed into associated to a worse prognosis,” wrote the authors of the leer.

SOURCE:

The leer changed into led by Derya Tilki, MD, Martini-Klinik Prostate Cancer Heart, University Health center Hamburg-Eppendorf in Hamburg, Germany. It changed into printed on-line on March 13 in JAMA Oncology.

LIMITATIONS:

In accordance to the authors, the validation cohort showed a vital association between lowered prostate cancer–particular mortality possibility but now not all-reason mortality possibility in patients with persistent PSA and pre-RP PSA > 20 ng/mL vs ≤ 20 ng/mL. This limitation might presumably well presumably even be outlined by the restricted energy to evaluate the all-reason mortality endpoint given the shorter median apply-up and smaller tournament fee within the validation cohort when compared with the discovery cohort.

DISCLOSURES:

Tilki reported receiving deepest charges from Amgen, Apogepha, AstraZeneca, Astellas, A3P Biomedical, Bayer, Exact Sciences, Johnson & Johnson, Ipsen, Novartis, Pfizer, Roche, Veracyte, and Takeda birth air the submitted work. No a mode of disclosures had been reported.

This text changed into created the use of several editorial tools, including AI, as piece of the approach. Human editors reviewed this stammer sooner than newsletter.