Metastatic prostate cancer in the modern era of PSA screening

Vol. 43 (3): 416-421, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0340


ORIGINAL ARTICLE

Philip A. Fontenot Jr. 1, Avinash Nehra 1, William Parker 1, Hadley Wyre 1, Moben Mirza 1, David A. Duchene 1, Jeffrey Holzbeierlein 1, James Brantley Thrasher 1, Peter Van Veldhuizen 2, Eugene K. Lee 1
1 Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA; 2 Division of Hematology/Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA

ABSTRACT

Introduction: To characterize initial presentation and PSA screening status in a con­temporary cohort of men treated for metastatic prostate cancer at our institution.

Materials and methods: We reviewed records of 160 men treated for metastatic prostate cancer between 2008-2014 and assessed initial presentation, categorizing patients into four groups. Groups 1 and 2 presented with localized disease and received treatment. These men suffered biochemical recurrence late (>1 year) or earlier (<1 year), respec­tively, and developed metastases. Groups 3 and 4 had asymptomatic and symptom­atic metastases at the outset of their diagnosis. Patients with a first PSA at age 55 or younger were considered to have guideline-directed screening.

Results: Complete records were available on 157 men for initial presentation and 155 men for PSA screening. Groups 1, 2, 3 and 4 included 27 (17%), 7 (5%), 69 (44%) and 54 (34%) patients, respectively. Twenty (13%) patients received guideline-directed PSA screening, 5/155 (3%) patients presented with metastases prior to age 55 with their first PSA, and 130/155 (84%) had their first PSA after age 55, of which 122/130 (94%) had metastasis at the time of diagnosis.

Conclusion: Despite widespread screening, most men treated for metastatic prostate cancer at our institution presented with metastases rather than progressed after defini­tive treatment. Furthermore, 25 (16%) patients received guideline-directed PSA screen­ing at or before age 55. These data highlight that, despite mass screening efforts, patients treated for incurable disease at our institution may not have been a result of a failed screening test, but a failure to be screened.

Keywords: Prostate-Specific Antigen; Neoplasms; Prostate

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