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Combination of prostate-specific antigen (PSA) exposure and Gleason score as prognostic factors for prostate cancer (PC) patients

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în revistã ştiinţificã

Autori: A. Banu, S. Oudard, E. Banu, D. Kamioneur, M. Housset, N. Thiounn, F. Scotte, A. Jenabian, A. Mejean, J. M. Andrieu

Editorial: Poster presentation. Abstract 73. Proceedings of Prostate Cancer Symposium, 17 February, Orlando, Florida 2005:70., 2005.


Background: Predicting outcome for men with PC, treated with curative intent, remains imprecise and further evaluation of accepted and potential predictive factors is needed. Methods: The PSA exposure (PSA dynamics during lifetime) was estimated by corrected area under PSA curve [(PSA c-AUC), ASCO 2004]. Based on their PSA c-AUC values (< 60 vs > 60 ng/mL) and Gleason score (5-7 vs 8-10), patients were analyzed according to time from primary diagnosis (TPD) as major survival endpoint. TPD was calculated from primary diagnosis until death or last follow-up. A prognostic scoring system was created using the Kaplan-Meier test to classify patients according to risk of death. Our model identified four risk groups with predicted 3-, 5-, 7-, 10-, 13-, 15- and 18-year TPD percentages. Associated 95% confidence interval (CI) were calculated. Results: Four hundred thirty PC patients were included in this analysis. Patients characteristics: median age at initial diagnosis was 64 years (range 41-82 years), median PSA follow-up duration of 2.6 years (range 0.1-16.1 years). There were significant TPD differences (P = 0.00001) according to risk group (Table 1). The median TPD for the low PSA c-AUC (< 60 ng/mL) groups was similar, independently of Gleason score (5-7 vs 8-10), [10.1 years (95% CI 8.6-11.7 years) vs 9.7 years (95% CI 6.2-13.1 years)]. Only 25% of patients in high risk group (Gleason > 8 and PSA c-AUC > 60 ng/mL) are alive at 5 years, with a median TPD of 2.9 years (95% CI 2-3.8 years), two times lower than Gleason 5-7 and PSA c-AUC > 60 ng/mL group [median of 7.3 years (95% CI 5.1-9.4 years), 67% alive]. Conclusions: By combining PSA c-AUC with Gleason score, we were able to predict TPD survival probabilities and to identify a high-risk patient group. A higher PSA exposure (> 60 ng/mL) during lifetime was correlated with a higher mortality. Consequently, these patients are candidates for early agressive treatments in phase II-III clinical trials.

Cuvinte cheie: cancer de prostata, scor Gleason, expozitie PSA, supravietuire // prostate cancer, Gleason score, PSA exposure, survival