PSA paradox: Low levels predict poor prognosis in high-grade PCa

In men with high-grade prostate cancer, outcomes after radical prostatectomy are generally poorest for those with a low preoperative PSA (

Researchers from Northwestern University’s Feinberg School of Medicine, Chicago undertook a retrospective analysis that identified men who had undergone radical prostatectomy between 1983 and 2011 and who had a Gleason score of 8-10 in their prostatectomy specimen. A total of 354 patients met these criteria, and they were stratified into four groups based on their preoperative PSA:

Median duration of follow-up was 77 months, and 7-year outcomes were calculated for each PSA subgroup for biochemical progression-free survival, metastasis-free survival, and cancer-specific survival rates. For all three endpoints, men with a PSA

The 7-year metastasis-free survival rate for men with PSA

"These data should provide a wake-up call to physicians who might think there is no need to perform a biopsy in men whose PSA remains low or who might be less concerned about disease aggressiveness in a patient found to have a high-grade tumor but who has a low PSA level," said Dr. McGuire.

He added that the explanation for the paradoxical relationship between PSA level and tumor aggressiveness among men with Gleason 8-10 tumors lies in the knowledge that high-grade tumors that are very poorly differentiated can lose their ability to produce PSA.