High risk Prostate cancer

Baseline PSA of 10 ng/mL or greater, Gleason scores of 8 to 10, and younger age are associated with a shorter time to prostate-specific antigen (PSA) failure following treatment in men with nonmetastatic unfavorable-risk prostate cancer.

A shorter time interval from treatment to PSA failure correlates with worse clinical outcomes in men with prostate cancer.

A study included 350 men with localized unfavorable-risk prostate cancer who received 6 months of androgen deprivation therapy and radiation therapy with or without docetaxel.

After a median follow-up of 10 years, the researchers identified three factors associated with time to PSA failure. 

PSA levels between 10 ng/mL and 20 ng/mL and Gleason scores of 8 to 10 were associated with a shorter time to PSA failure.

Older age, however, was associated with a lower risk for PSA failure.

The researchers then divided patients into a high- and low-risk category based on these three factors, with the high-risk category defined as younger than 70 years, a PSA of 10 ng/mL or higher, and a Gleason score of 8 to 10.

Men in the high-risk group had a significantly higher risk of early PSA failure compared with men in the low-risk group.

The high-risk group had a nearly 44% risk of PSA failure at 3 years.

Men who received pelvic radiation therapy also had a significantly lower risk for PSA recurrence.

The subgroup of men at high risk for early PSA failure, as defined in this study, may benefit from treatment escalation with androgen receptor signaling inhibitors or cytotoxic chemotherapy and should be the subject of a prospective randomized clinical trial.

BRCA2 and ATM are associated with aggressive and metastatic prostate cancer.

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