Prognosis of prostate cancer with initial prostate-specific antigen > 1,000 ng/mL at diagnosis

Hung Cheng Kan, Chen Pang Hou, Yu Hsiang Lin, Ke Hung Tsui, Phei Lang Chang, Chien Lun Chen

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Purpose: Prostate cancer patients with surprisingly high prostate-specific antigen (PSA) are encountered clinically. However, descriptions of this group of patients are extremely rare in the published literature. This study reports treatment outcome and long-term prognosis for this group of patients. Patients and methods: Between January 2007 and December 2012, 2,064 patients with PCa diagnosed at a tertiary medical center were retrospectively reviewed. A total of 90 PCa cases were identified with initial PSA (iPSA)>1,000 ng/mL at diagnosis. A retrospective study was conducted in this cohort, with comparison among stratified patient age groups, PSA, treatment options, and overall survival. Results: The mean PSA at PCa diagnosis in this cohort was 3,323 ng/mL (1,003-23,126, median: 2,050 ng/mL). Most patients were in the age group 65-79 years (55/90, 61%). Males older than 80 years had a poor prognosis (P<0.001). Forty-six patients (51%) underwent orchiectomy with a median follow-up period of 16.2 (1.3-72.7) months, compared to 44 patients treated with medical castration and a median follow-up of 9.1 (0.3-70.5) months. Kaplan-Meier analysis revealed survival benefit from treatment with orchiectomy (P<0.001). PSA reduction >90% of iPSA following primary androgen deprivation therapy (reaching true nadir) could be a predictor of longer survival (P<0.001). Cox regression revealed the hazard ratio (HR) of variables were age (HR: 4.57, 95% confidence interval [CI]: 1.45-14.37, P=0.009), reaching true nadir (HR: 0.12, 95% CI: 0.03-0.58, P=0.008), and the treatment option with orchiectomy (HR: 0.22, 95% CI: 0.65-0.76, P=0.016). Conclusion: Age ≥80 years indicated poor overall survival in PCa patients with iPSA>1,000 ng/mL. Reaching a true nadir of PSA following primary androgen deprivation therapy could be a predictor of longer survival. Bilateral orchiectomy is recommended for this group of patients.

Original languageEnglish
Pages (from-to)2943-2949
Number of pages7
JournalOncoTargets and Therapy
Publication statusPublished - Jun 2017
Externally publishedYes


  • Androgen deprivation
  • Nadir
  • Orchiectomy
  • Prostate cancer
  • PSA

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)


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