PSA Trajectory in nmCRPC Predicts Metastasis, Mortality Risk

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Metastasis and death are more likely to occur among patients with relatively high PSA levels at diagnosis of nmCRPC and rising PSA levels during follow-up.
Metastasis and death are more likely to occur among patients with relatively high PSA levels at diagnosis of nmCRPC and rising PSA levels during follow-up.
The following article is part of conference coverage from the 2018 Genitourinary Cancers Symposium in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from GU 2018.

SAN FRANCISCO—Patients with non-metastatic castration-resistant prostate cancer (nmCRPC) who have higher PSA trajectories are at greater risk for metastasis and death, according to study findings presented at the 2018 Genitourinary Cancers Symposium.

Sophia Li, MD, of Janssen Scientific Affairs in Horsham, Pennsylvania, and colleagues placed 729 patients with nmCRPC into 4 groups based on PSA trends over 9 months. Group 1 included patients with the lowest PSA level (7 ng/mL) at nmCRPC diagnosis and steady PSA levels during the 9-month follow-up. Groups 2, 3, and 4 had higher PSA levels at diagnosis (17, 61, and 513 ng/mL, respectively) and rising PSA during follow-up. Groups 1, 2, 3, and 4 included 355 (49% of the study population), 235 (32%), 103 (14%), and 36 patients (5%), respectively.

Groups 2 and 3 had a significant 1.7- and 3.5-fold increased risk for metastasis, respectively, compared with group 1, the investigators reported. The association between group 4 and metastasis was non-significant and likely due to small sample size and/or under reporting of metastases, the authors noted.

Groups 2, 3, and 4 had a significant 1.9-, 2.6-, and 4.5-fold greater risk for death, respectively, compared with group 1

The overall survival rate at year 1 for the entire study population was 83.9%. The survival rates at year 1 for groups 1, 2, 3, and 4 were 94%, 92%, 77%, and 72%, respectively, according to the investigators. Patients developing metastasis within 1 had a greater than 4-fold increased risk for death than those who remained free of metastasis at year 3.

The investigators concluded that periodic measurement of PSA levels may allow more accurate risk prediction, which would better inform management of nmCRPC. In addition, metastasis-free survival may serve as a surrogate for subsequent mortality in nmCRPC patients.

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Reference

Li S, Ding Z, Lin JH, et al. Association of prostate-specific antigen (PSA) trajectories with risk for metastasis and mortality in non-metastatic castration-resistant prostate cancer (nmCRPC). Data presented at the 2018 Genitourinary Cancers Symposium, held in San Francisco Feb. 8-10. Abstract 27.

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