title: Clinical features of patients who present with metastatic prostate carcinoma and serum prostate-specific antigen (PSA) levels < 10 ng/mL: the "PSA negative" patients.
abstract: BACKGROUND
  Although < 1% of men present with prostate-specific antigen (PSA)-negative prostate carcinoma, in that they have serum PSA levels much lower than the tumor burden would suggest, such patients represent a management dilemma. To the authors' knowledge, little information exists in the literature regarding patterns of disease and response to treatment. The authors wished to define the clinical features of this patient group.
  
  
  METHODS
  The British Association of Urological Surgeons Cancer Registry 2000 and 2001 data bases were used to identify the clinical features and outcome of 33 men with metastatic prostate carcinoma who presented with serum PSA levels < 10 ng/mL. Clinical notes and histopathology were reviewed for each patient.
  
  
  RESULTS
  Seventeen patients (51%) presented with urinary symptoms and/or pelvic pain, 6% with cachexia and 21% with bone pain. Characteristic bone metastases were present in 81% of patients, similar to the presentation of men with high serum PSA levels. Hypercalcemia was a feature in 9% of patients. Visceral metastases were present in two patients. The median response duration to first-line hormone manipulation was 7 months. No responses were seen in 11 of 13 patients who received second-line hormones or to any third-line treatment. Three of 5 patients who received chemotherapy responded but developed recurrent disease within 8 weeks of treatment cessation. The median overall survival was 12 months.
  
  
  CONCLUSIONS
  The presentation of patients with treatment-naïve PSA-negative metastatic prostate carcinoma is similar to that of patients with high serum PSA levels, but their median survival and response duration to first-line hormone therapy are of much shorter duration. Second-line hormone therapy is ineffective, but early chemotherapy may be beneficial. Hypercalcemia is a particular feature in this group of patients.
authors.affiliation: Prostate Cancer Research Center, The Institute of Urology, University College London, London, United Kingdom. alison_birtle@hotmail.com
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Birtle
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.forename: John R W
authors.initials: JR
authors.lastname: Masters
authors.forename: Heather A
authors.initials: HA
authors.lastname: Payne
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Harland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D002277:Carcinoma / Q000150:complications / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology*; D012016:Reference Values; D012042:Registries / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen