What Can Be Learned from PSA Levels at Death in mCRPC?

Prostate-specific antigen (PSA) levels at or near the time of death in patients with metastatic castration-resistant prostate cancer (mCRPC) may be significant, a study suggests. The results were published in Clinical Genitourinary Cancer.

The researchers collected data from the Mount Sinai Genitourinary Cancer Biorepository on patients seen between 2010 and 2019. Patients were stratified by PSA at or near the time of death in the following groups: <100 ng/mL, 100–1000 ng/mL, and >1000 ng/mL. Clinical disease characteristics, treatment response, and outcomes were all evaluated.

Of 1,097 patients with prostate cancer, there were 101 confirmed deaths among patients with mCRPC. In this group, a correlation was observed between higher PSA level at death and lower Gleason score at diagnosis, as well as a trend toward longer time to mCRPC and longer time from diagnosis to death.

The researchers performed a subgroup analysis of patients with PSA <10 ng/mL and found correlations with lower rates of imaging within six months of death, lower treatment rate, and worse clinical outcomes.

“Cohorts of different PSA levels at death in mCRPC patients showed distinct patterns of disease characteristics and clinical outcomes, likely due to the underlying molecular phenotype differences. Imaging for the patient population with very low PSA levels may be underutilized and should be considered more routinely,” the researchers stated in their conclusion.