Low PSA at diagnosis.

[pjoshea13]

New study below [1].

In 2002, at age 54, a DRE discovered a nodule on my prostate. PSA was 0.8. The first biopsy was negative, but a second, when the PSA had climbed to 3.0, uncovered Gleason 4+3 PCa. Which is why I find the new study interesting.

"Patients with a PSA <4.0 ng/ml had poorer PCSS {prostate cancer-specific survival} than patients with a PSA 4.0-10.0 ng/ml. Similar PCSS was found in patients whose PSA levels were 10.1-20.0 ng/ml in patients with GS 9-10 prostate cancer."

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/321...

Int J Surg

2020 Feb 25[Online ahead of print]

Reduced Cancer-Specific Survival of Low Prostate-Specific Antigen in High-Grade Prostate Cancer: A Population-Based Retrospective Cohort Study

Pan Song 1 , Bo Yang 1 , Zhufeng Peng 1 , Jing Zhou 1 , Zhengju Ren 1 , Kun Fang 1 , Luchen Yang 1 , Linchuan Wang 1 , Qiang Dong 2

Affiliations collapse

Affiliations

1 Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.

2 Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. Electronic address: [e-mail].

PMID: 32109649 DOI: 10.1016/j.ijsu.2020.02.024

Abstract

Objective: The aim of this study was to evaluate the survival outcomes of different prostate-specific antigens (PSA) levels in men with high-grade prostate cancer.

Materials and methods: From 2004-2015 in the Surveillance, Epidemiology, and End Results database, men diagnosed with clinically localized prostate cancer and a Gleason score (GS) 8-10 were identified. Patients were divided into the PSA levels <4.0 ng/ml, 4.0-10.0 ng/ml, 10.1-20.0 ng/ml, and >20.0 ng/ml groups. Multivariable Cox regressions and Kaplan-Meier analysis were adopted to analyze the prostate cancer-specific survival (PCSS).

Results: 59,336 men with a median age of 70 (63∼76) years with a GS 8-10 were included. The PCSS of patients with a PSA <4.0 ng/ml was significantly worse than that of patients with a PSA 4.0-10.0 ng/ml [hazard ratio (HR): 1.43 (1.28∼1.58)], but was better than that of patients with a PSA 10.1-20.0 ng/ml [HR: 1.18 (1.06∼1.31)]. After stratifying patients by GS, the differences between patients with a PSA <4.0 ng/ml and a PSA 4.0-10.0 ng/ml were only significant in those with a GS 9 and 10 [GS 9 HR: 1.49 (1.28∼1.72); GS 10 HR: 1.42 (1.12∼1.8)], but not in those with a GS 8 [HR: 1.04 (0.95∼1.14)]. Moreover, the PCSS of patients with a PSA < 4.0 ng/ml and a PSA 10.0-20.0 ng/ml were similar in patients with GS 9 and 10 diseases [GS 9: HR: 1.06 (0.91∼1.23); GS 10: HR: 1.13 (0.89∼1.44)].

Conclusions: Patients with a PSA <4.0 ng/ml had poorer PCSS than patients with a PSA 4.0-10.0 ng/ml. Similar PCSS was found in patients whose PSA levels were 10.1-20.0 ng/ml in patients with GS 9-10 prostate cancer.

Keywords: Gleason score; Prostate cancer; Prostate-specific antigen; Survival.

Copyright © 2020. Published by Elsevier Ltd.

[snoraste]

I wonder if that's because of presence of neuroendorine cells in high grade/low PSA cohort.

[pjoshea13 in reply to snoraste]

Nalakrats brought that up with me at one of our lunches. Somehow, I doubt that was the case for me 16-18 years ago. Also, you expect those cells in heavily treated men - not at diagnosis.

Low PSA suggest to me that the men were entirely free from BPH. Brings to mind the late detection of some men on Avodart, etc.

-Patrick

[LearnAll in reply to pjoshea13]

How much PSA is produced.. indicates the degree of deformity of cancer cells. The day job of prostate cells is to produce PSA to liquify semen. The PCa cells who maintain their civilian duty of producing PSA are still least deformed and least aggressive.

When the PCa cells become aggressive they lose their capacity to produce PSA and become mean, deformed ,distorted and very insecure..very eager to reproduce quickly.

PSA producing cells are like doves....PSA non producing cells are like devils who want to kill the host fast.

Therefore, the most aggressive PCa is comprised of minimum PSA producing cells just like Neuroendocrine cells.

[AlanMeyer]

One possible problem with the study is that men may have low PSA for different reasons. A relatively small number of neuroendocrine afflicted patients in the low PSA group might drag down the mean survival numbers for the group as a whole and, since men with PSA 4-10 are much less likely to have neuroendocrine disease, they look better than the 0-4 group. It might be the case that, if the patients were stratified by 0-2 vs 2-4 vs 4-10, the 2-4 group would come out best and the 0-2 group worst.

Alan

[Don_1213]

I wonder if there is a correlation between low PSA at diagnosis and a delayed diagnosis due to the low PSA number? That could explain the PCSS number being lower.

[Hidden]

Hmmm. My PSA was 2.7 at time of gleason 8 diagnosis. I had had TURP surgery 11 years prior to diagnosis having suffered from BPH for a few years. Could my low PSA been a result of having my prostate 'cored out' (roto-rooter) by the TURP surgery? Anyway, maybe I'm in trouble but I see that you've had a good survival period following your diagnosis and I wish you many more years.

[GeorgesCalvez]

I think it comes down to what everyone knows.

Gleason Grades do not tell the whole story, it is possible to have Grade 4 cells that are actually more like Grade 5 cells, they may look innocent but they are more like wolves in sheep's clothing and the clue is in the low PSA output.

[Rocketman1960]

Fascinating. More proof each case is different with too many variables to evaluate. I know I would rather be a Gleason 4+4=8 then a 3+5=8 or 2+5=7 or 1+5=6.

[immunity1]

This finding has been known for some years (?source) and was my experience in 2010, with adenocarcinoma. Gl9 with PSA 4.5 after yearly blood analyses. NE may have skewed these published results. Some of us are just low PSA producers. =R