Department of Emergency Medicine, University of Texas Medical Branch, Galveston, TX.
Department of Emergency Medicine, University of Texas Medical Branch, Galveston, TX.
Clin Genitourin Cancer. 2024 Oct;22(5):102162. doi: 10.1016/j.clgc.2024.102162. Epub 2024 Jul 14.
Prostate cancer (PC) is the second most common cancer among men around the world. Several smaller studies have explored the relationship between elevated PSA and mortality, but results have been conflicting. Additionally, studies have shown that Black men are more likely to be diagnosed with PC at late-stages and may have a twofold increase in mortality risk. This study aims to evaluate the relationship between PSA levels and mortality in patients with PC and differences between Black versus White patients.
In this retrospective study, the TriNetX database, was used to extract de-identified EMRs of 198,083 patients. Patients were included if they were diagnosed with PC and had obtained a PSA level (measured in ng/mL) within 6 months prior to diagnosis. Cohorts were separated into 7 groups based on intervals of PSA, ranging from < 2 to ≥ 500 and compared to a control cohort with a PSA of 4 to 20 for differing 2-year mortality rates. A subgroup analysis was performed to compare mortality differences between Black and White patients. A posthoc analysis evaluated 5- and 10-year mortality amongst all patients with PC.
After propensity matching, mortality risk was significantly lower for patients with PSA < 2 (5.9% vs. 7.5%; RR 0.784; P < .001) when compared to the control cohort. Mortality was significantly higher for all other subsequent PSA intervals > 20, with the lowest risk ratios at PSA 20-100 (24.1% vs. 10.0%; RR 2.419; P < .001) and highest at PSA 200 to 500 (50.4% vs. 10.8%; RR 4.673; P < .001). The sub-group analysis showed that when compared to White patients, Black patients with PSA < 20 had similar mortalities, but had significantly lower 2-year mortality rates at PSA levels ≥ 20. The posthoc analysis of PSA levels and 5- and 10-year mortality of all patients with PC showed similar trends to the 2-year outcomes.
This study found that prostate cancer patients with significantly elevated PSA levels have a greater mortality, and Black patients have lower 2-year mortality rates than their White counterparts when matched for PSA levels greater than 20.
前列腺癌（PC）是全球男性中第二常见的癌症。一些较小的研究探讨了 PSA 升高与死亡率之间的关系，但结果存在矛盾。此外，研究表明，黑人男性更有可能被诊断为晚期前列腺癌，并且死亡率风险可能增加两倍。本研究旨在评估 PC 患者 PSA 水平与死亡率之间的关系以及黑人和白人患者之间的差异。
在这项回顾性研究中，使用 TriNetX 数据库提取了 198083 名患者的去识别电子病历。如果患者被诊断为 PC 并且在诊断前 6 个月内获得了 PSA 水平（以 ng/mL 为单位），则将其纳入研究。根据 PSA 间隔分为 7 组，范围从<2 到≥500，并与 PSA 为 4 至 20 的对照组进行比较，以比较不同 2 年死亡率的队列。进行亚组分析以比较黑人和白人患者之间的死亡率差异。事后分析评估了所有 PC 患者的 5 年和 10 年死亡率。
在倾向匹配后，与对照组相比，PSA<2 的患者死亡率明显较低（5.9% vs. 7.5%；RR 0.784；P<.001）。所有其他后续 PSA 间隔>20 的患者死亡率均显著升高，PSA 20-100 时风险比最低（24.1% vs. 10.0%；RR 2.419；P<.001），PSA 200-500 时最高（50.4% vs. 10.8%；RR 4.673；P<.001）。亚组分析表明，与白人患者相比，PSA<20 的黑人患者死亡率相似，但 PSA≥20 时 2 年死亡率显著较低。对所有 PC 患者 PSA 水平与 5 年和 10 年死亡率的事后分析显示出与 2 年结果相似的趋势。
本研究发现，PSA 水平显著升高的前列腺癌患者死亡率更高，并且与 PSA 水平大于 20 的白人患者相比，黑人患者的 2 年死亡率更低。
