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Characteristics and outcome of prostate cancer with PSA <4 ng/ml at diagnosis: a population-based study

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Abstract

Introduction

This population-based study aims to assess prognosis of prostate cancer diagnosed with prostate-specific antigen (PSA) levels <4 ng/ml in routine care.

Materials and methods

We compared prostate cancer patients with low PSA values (n=59) with other prostate cancer patients (n=1330) by logistic regression and the Cox model using data from the Geneva Cancer Registry.

Results

Patients with low PSA values more frequently had early-stage and well differentiated tumours. Nevertheless, 35% presented with aggressive tumour characteristics or metastases. After adjustment for other prognostic factors, prostate cancer-specific mortality was similar for both groups (hazard ratio: 1.1; 95%CI: 0.6–2.2).

Conclusion

We conclude that cancer with low PSA values at diagnosis is not indolent.

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References

  1. American Urological Association (AUA). Prostate-specific antigen (PSA) best practice policy. http://www.cancernetwork.com/journals/oncology/o0002e.htm#Early. Accessed 1 March 2006

  2. Schroder FH, van der Cruijsen-Koeter I, De Koning HJ et al (2000) Prostate cancer detection at low prostate specific antigen. J Urol 163:806–812

    Article  PubMed  CAS  Google Scholar 

  3. Thompson IM, Pauler DK, Goodman PJ et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med 350:2239–2246

    Article  PubMed  CAS  Google Scholar 

  4. Babaian RJ, Johnston DA, Naccarato W et al (2001) The incidence of prostate cancer in a screening population with a serum prostate specific antigen between 2.5 and 4.0 ng/ml: relation to biopsy strategy. J Urol 165:757–760

    Article  PubMed  CAS  Google Scholar 

  5. Lodding P, Aus G, Bergdahl S et al (1998) Characteristics of screening detected prostate cancer in men 50 to 66 years old with 3 to 4 ng/ml. Prostate specific antigen. J Urol 159:899–903

    Article  PubMed  CAS  Google Scholar 

  6. Catalona WJ, Smith DS, Ornstein DK (1997) Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination. Enhancement of specificity with free PSA measurements. JAMA 277:1452–1455

    Article  PubMed  CAS  Google Scholar 

  7. Raaijmakers R, Blijenberg BG, Finlay JA et al (2004) Prostate cancer detection in the prostate specific antigen range of 2.0 to 3.9 ng/ml: value of percent free prostate specific antigen on tumor detection and tumor aggressiveness. J Urol 171:2245–2249

    Article  PubMed  Google Scholar 

  8. Kobayashi T, Mitsumori K, Kawahara T et al (2006) Prostate cancer detection among men with prostate specific antigen levels of 2.5 to 4.0 ng/ml in a Japanese urological referral population. J Urol 175:1281–1285

    Article  PubMed  CAS  Google Scholar 

  9. Postma R, Schroder FH, van Leenders GJ et al (2007) Cancer detection and cancer characteristics in the European Randomized Study of Screening for Prostate Cancer (ERSPC)—Section Rotterdam. A comparison of two rounds of screening. Eur Urol 52:89–97

    Article  PubMed  Google Scholar 

  10. Aus G, Robinson D, Rosell J et al (2005) Survival in prostate carcinoma — outcomes from a prospective, population-based cohort of 8887 men with up to 15 years of follow-up: results from three countries in the population-based National Prostate Cancer Registry of Sweden. Cancer 103:943–951

    Article  PubMed  Google Scholar 

  11. Makarov DV, Humphreys EB, Mangold LA et al (2006) Pathological outcomes and biochemical progression in men with T1c prostate cancer undergoing radical prostatectomy with prostate specific antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml. J Urol 176:554–558

    Article  PubMed  CAS  Google Scholar 

  12. Shekarriz B, Upadhyay J, Bianco FJ Jr et al (2001) Impact of preoperative serum PSA level from 0 to 10 ng/ml on pathological findings and disease-free survival after radical prostatectomy. Prostate 48:136–143

    Article  PubMed  CAS  Google Scholar 

  13. Antenor JA, Roehl KA, Eggener SE et al (2005) Preoperative PSA and progression-free survival after radical prostatectomy for Stage T1c disease. Urology 66:156–160

    Article  PubMed  Google Scholar 

  14. Stamey TA, Johnstone IM, McNeal JE et al (2002) Preoperative serum prostate specific antigen levels between 2 and 22 ng/ml correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng/ml. J Urol 167:103–111

    Article  PubMed  CAS  Google Scholar 

  15. D’Amico AV, Chen MH, Malkowicz SB et al (2002) Lower prostate specific antigen outcome than expected following radical prostatectomy in patients with high grade prostate and a prostatic specific antigen level of 4 ng/ml or less. J Urol 167:2025–2030

    Article  PubMed  Google Scholar 

  16. Berger AP, Spranger R, Kofler K et al (2003) Early detection of prostate cancer with low PSA cut-off values leads to significant stage migration in radical prostatectomy specimens. Prostate 57:93–98

    Article  PubMed  Google Scholar 

  17. Freedland SJ, Aronson WJ, Kane CJ et al (2004) Biochemical outcome after radical prostatectomy among men with normal preoperative serum prostate-specific antigen levels. Cancer 101:748–753

    Article  PubMed  Google Scholar 

  18. Zhu H, Roehl KA, Antenor JA, Catalona WJ (2005) Biopsy of men with PSA level of 2.6 to 4.0 ng/mL associated with favorable pathologic features and PSA progression rate: a preliminary analysis. Urology 66:547–551

    Article  PubMed  Google Scholar 

  19. Carter HB, Epstein JI, Partin AW (1999) Influence of age and prostate-specific antigen on the chance of curable prostate cancer among men with non-palpable disease. Urology 53:126–130

    Article  PubMed  CAS  Google Scholar 

  20. Noldus J, Stamey TA (1996) Histological characteristics of radical prostatectomy specimens in men with a serum prostate specific antigen of 4 ng/ml or less. J Urol 155:441–443

    Article  PubMed  CAS  Google Scholar 

  21. Krumholtz JS, Carvalhal GF, Ramos CG et al (2002) Prostate-specific antigen cutoff of 2.6 ng/mL for prostate cancer screening is associated with favorable pathologic tumor features. Urology 60:469–473

    Article  PubMed  Google Scholar 

  22. Carter HB, Epstein JI, Chan DW et al (1997) Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer. JAMA 277:1456–1460

    Article  PubMed  CAS  Google Scholar 

  23. Kupelian P, Katcher J, Levin H et al (1996) Correlation of clinical and pathologic factors with rising prostate-specific antigen profiles after radical prostatectomy alone for clinically localized prostate cancer. Urology 48:249–260

    Article  PubMed  CAS  Google Scholar 

  24. World Health Organization (WHO) (1976) ICD-O International classification of diseases for oncology, 1st Edn. World Health Organization, Geneva

    Google Scholar 

  25. Sobin LH, Wittekind Ch (2002) TNM classification of malignant tumours, 6th Edn. UICC, New York

    Google Scholar 

  26. Greenwood M (1926) The natural duration of cancer, 33rd Edn. Her Majesty’s Stationary Office, London

    Google Scholar 

  27. Babaian RJ, Fritsche H, Ayala A et al (2000) Performance of a neural network in detecting prostate cancer in the prostate-specific antigen reflex range of 2.5 to 4.0 ng/mL. Urology 56:1000–1006

    Article  PubMed  CAS  Google Scholar 

  28. Preston DM, Bauer JJ, Connelly RR et al (1999) Prostate-specific antigen to predict outcome of external beam radiation for prostate cancer: Walter Reed Army Medical Center experience, 1988–1995. Urology 53:131–138

    Article  PubMed  CAS  Google Scholar 

  29. Gilligan T, Wang PS, Levin R et al (2004) Racial differences in screening for prostate cancer in the elderly. Arch Intern Med 164:1858–1864

    Article  PubMed  Google Scholar 

  30. Conlisk EA, Lengerich EJ, Demark-Wahnefried W et al (1999) Prostate cancer: demographic and behavioral correlates of stage at diagnosis among blacks and whites in North Carolina. Urology 53:1194–1199

    Article  PubMed  CAS  Google Scholar 

  31. Tarman GJ, Kane CJ, Moul JW et al (2000) Impact of socioeconomic status and race on clinical parameters of patients undergoing radical prostatectomy in an equal access health care system. Urology 56:1016–1020

    Article  PubMed  CAS  Google Scholar 

  32. Harvei S, Kravdal O (1997) The importance of marital and socioeconomic status in incidence and survival of prostate cancer. An analysis of complete Norwegian birth cohorts. Prev Med 26: 623–632

    Article  PubMed  CAS  Google Scholar 

  33. Byers TE, Wolf HJ, Bauer KR et al (2008) The impact of socioeconomic status on survival after cancer in the United States: findings from the National Program of Cancer Registries Patterns of Care Study. Cancer 113:582–591

    Article  PubMed  Google Scholar 

  34. Partin AW, Hanks GE, Klein EA et al (2002) Prostate-specific antigen as a marker of disease activity in prostate cancer. Oncology (Williston Park) 16:1024–1038, 1042

    Google Scholar 

  35. Zagars GK, Pollack A (1995) Radiation therapy for T1 and T2 prostate cancer: prostate-specific antigen and disease outcome. Urology 45:476–483

    Article  PubMed  CAS  Google Scholar 

  36. Partin AW, Pound CR, Clemens JQ et al (1993) Serum PSA after anatomic radical prostatectomy. The Johns Hopkins experience after 10 years. Urol Clin North Am 20:713–725

    PubMed  CAS  Google Scholar 

  37. D’Amico AV, Hui-Chen M, Renshaw AA et al (2006) Identifying men diagnosed with clinically localized prostate cancer who are at high risk for death from prostate cancer. J Urol 176:S11–S15

    Article  PubMed  Google Scholar 

  38. Partin AW, Carter HB, Chan DW et al (1990) Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. J Urol 143:747–752

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Radiation Oncology, Geneva University Hospitals, Avenue de la Roseraie 53, 1205, Geneva, Switzerland

    Marta Bonet & Raymond Miralbell

  2. Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain

    Marta Bonet

  3. Geneva Cancer Registry Institute for Social and Preventive Medicine, Geneva University, 55 Boulevard de la Cluse, 1205, Geneva, Switzerland

    Arnaud Merglen, Gérald Fioretta, Elisabetta Rapiti, Isabelle Neyroud-Caspar & Christine Bouchardy

  4. Piedmont Cancer Registry, CPO, Via San Francesco da Paola 31, 10123, Turin 1, Italy

    Roberto Zanetti

Authors
  1. Marta Bonet
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  2. Arnaud Merglen
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  3. Gérald Fioretta
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  4. Elisabetta Rapiti
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  5. Isabelle Neyroud-Caspar
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  6. Roberto Zanetti
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  7. Raymond Miralbell
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  8. Christine Bouchardy
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Correspondence to Christine Bouchardy.

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Bonet, M., Merglen, A., Fioretta, G. et al. Characteristics and outcome of prostate cancer with PSA <4 ng/ml at diagnosis: a population-based study. Clin Transl Oncol 11, 312–317 (2009). https://doi.org/10.1007/s12094-009-0359-1

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  • DOI: https://doi.org/10.1007/s12094-009-0359-1

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