Clinical Outcomes and Prognostic Significance of PSA90 in Patients With Prostate Cancer and Initial PSA >1,000 ng/ml...

Prostate cancer (PCa) patients with an initial prostate-specific antigen (PSA) level >1,000 ng/ml at diagnosis represent a rare and high-risk subgroup for which prognostic factors remain poorly defined. Therefore, we investigated the clinical features of this population and identified predictors of overall survival (OS).

The present study retrospectively analyzed 35 patients diagnosed with PCa and initial PSA >1,000 ng/ml at our institution between August 2013 and December 2024. Clinical characteristics, treatment courses, PSA responses, and survival outcomes were collected. A nadir PSA level ≤0.2 ng/ml and a 90% decline in PSA from baseline (PSA90) were evaluated. OS was estimated using the Kaplan-Meier method, and the impact of clinical variables on OS was assessed using univariate and multivariate Cox proportional hazards regression models.

Median age was 74 years, and median initial PSA was 3,027 ng/ml. The median time to castration-resistant prostate cancer was 18.25 months, and median OS was 55.0 months. Univariate analyses revealed that PSA90 achievement correlated with longer OS, whereas age ≥75 years, an Eastern Cooperative Oncology Group performance status ≥1, elevated lactate dehydrogenase, and elevated C-reactive protein correlated with shorter OS. Multivariate analyses identified PSA90 achievement as the only independent predictor of prolonged OS (hazard ratio=0.13).

These results suggest the potential of PSA90 as a simple and valuable early biomarker for prognostic stratification in patients with PCa and initial PSA >1,000 ng/ml.