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

被引:0
作者
Slusarczyk, Aleksander [1 ]
Baboudjian, Michael [2 ]
Zapala, Piotr [1 ]
Yanagisawa, Takafumi [3 ,4 ]
Miszczyk, Marcin [5 ]
Chlosta, Marcin [3 ,6 ]
Krumpoeck, Paul [3 ]
Moschini, Marco [7 ]
Gandaglia, Giorgio [7 ]
Ploussard, Guillaume [8 ]
Rivas, Juan G. [9 ]
Zyczkowski, Marcin [10 ]
Karakiewicz, Pierre I. [11 ]
Radziszewski, Piotr [1 ]
Leapman, Michael S. [12 ]
Shariat, Shahrokh F. [3 ,13 ,14 ,15 ,16 ,17 ,18 ]
Rajwa, Pawel [3 ]
机构
[1] Med Univ Warsaw, Dept Gen Oncol & Funct Urol, Warsaw, Poland
[2] North Acad Hosp, APHM, Dept Urol, Marseille, France
[3] Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
[4] Jikei Univ, Dept Urol, Sch Med, Tokyo, Japan
[5] Mar Sklodowska Curie Natl Res Inst Oncol, Radiotherapy & Chemotherapy Dept 3, Warsaw, Poland
[6] Jagiellonian Univ Cracow, Dept Urol, Krakow, Poland
[7] IRCCS Osped San Raffaele, Urol Res Inst, Div Expt Oncol, Unit Urol, Milan, Italy
[8] Croix Sud Hosp, Dept Urol, Quint Fonsegr, France
[9] Clin San Carlos Hosp, Dept Urol, Madrid, Spain
[10] Med Univ Silesia, Dept Urol, Zabrze, Poland
[11] Univ Montreal, Canc Prognost & Hlth Outcomes Unit, Hlth Ctr, Montreal, PQ, Canada
[12] Yale Sch Med, Dept Urol, New Haven, CT USA
[13] Weill Cornell Med Coll, New York, NY USA
[14] Univ Texas Southwestern, Dept Urol, Dallas, TX USA
[15] Sechenov Univ, Inst Urol & Reprod Hlth, Moscow, Russia
[16] Karl Landsteiner Inst Urol & Androl, Vienna, Austria
[17] Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
[18] Al Ahliyya Amman Univ, Hourani Ctr Appl Sci Res, Dept Urol, Amman, Jordan
关键词
high PSA; nonmetastatic prostate cancer; prostate-specific antigen; radical prostatectomy; radiotherapy; survival; RADICAL PROSTATECTOMY; MEN; PSA; RISK; METASTASES; MORTALITY; VALUES; LEVEL;
D O I
10.1002/pros.24609
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundPatients 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. MethodsWe 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 & GE;50 and & GE;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). ResultsWe included 6177 patients with nmPCa and PSA & GE; 50 ng/mL at diagnosis; 1698 (27%) had PSA & GE; 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 & GE; 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 & GE; 50 ng/mL and RP subgroup, PSA failed to retain its independent prognostic value for CSS. ConclusionsPatients 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.
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收藏
页码:1504 / 1515
页数:12
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