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The impact of prostate-specific antigen level at diagnosis on the relative survival of 28,531 men with localized carcinoma of the prostate
Department of Surgery, University Hospital, Lund, Sweden, Department of Surgery, University Hospital, 221 85 Lund, Sweden.
Department of Urology, University Hospital, Uppsala, Sweden.
Center of Oncology, Uppsala, Uppsala University Hospital, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Urology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
2008 (English)In: Cancer, ISSN 0008-543X, Vol. 112, no 4, 813-819 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND. To evaluate the predictive value of prostate-specific antigen (PSA) in a population-based cohort, the authors analyzed relative survival in all men with localized prostate cancer who were registered in the Swedish National Prostate Cancer Register (NPCR) from 1996 to 2005. METHODS. All men aged <75 years with localized tumors were identified in the NPCR. A Poisson regression analysis was performed using observed death as response and the expected death rate as offset. The expected and observed numbers of survivors were calculated with stratification for PSA level and 3 categories of tumor differentiation (Gleason score 2-6, 7, and 8-10). The regression model included PSA as linear splines with a breakpoint at a PSA level of 4 ng/mL and with tumor differentiation as a categoric variable. RESULTS. The Poisson regression analysis indicated a U-shaped curve for all 3 groups, with a negative correlation between PSA and relative survival in men with PSA levels <4 ng/mL and a positive correlation for men with PSA levels >4 ng/mL. The correlation was significant for all 3 groups, but the negative correlation between PSA and relative survival was significantly more pronounced in the group with Gleason scores from 8 to 10 than in the other 2 Gleason score groups. CONCLUSIONS. The demonstration of an inverse correlation between PSA level and relative survival in the group of men with PSA levels <4 ng/mL indicated the presence of a small but clinically important subgroup with undifferentiated tumors who have cells that have lost the ability to secrete PSA. This group should be taken into consideration when deciding on treatment and when choosing a cutoff level in PSA screening programs. © 2007 American Cancer Society.

Place, publisher, year, edition, pages
2008. Vol. 112, no 4, 813-819 p.
Keyword [en]
Gleason score, Population-based, Prognosis, Prostate cancer, Prostate-specific antigen, Relative survival
National Category
Natural Sciences
URN: urn:nbn:se:liu:diva-46866DOI: 10.1002/cncr.23235OAI: diva2:267762
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2010-01-27

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Varenhorst, Eberhard
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Urology Faculty of Health SciencesDepartment of Urology in Östergötland
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