Metastatic prostate cancer in the modern era of PSA screening.
BACKGROUND
To characterize initial presentation and PSA screening status in a contemporary cohort of men treated for metastatic prostate cancer at our institution.


METHODS
We reviewed records of 160 men treated for metastatic prostate cancer between 2008-2014 and assessed initial presentation, categorizing patients into four groups. Groups 1 and 2 presented with localized disease and received treatment. These men suffered biochemical recurrence late (>1 year) or earlier (<1 year), respectively, and developed metastases. Groups 3 and 4 had asymptomatic and symptomatic metastases at the outset of their diagnosis. Patients with a first PSA at age 55 or younger were considered to have guideline-directed screening.


RESULTS
Complete records were available on 157 men for initial presentation and 155 men for PSA screening. Groups 1, 2, 3 and 4 included 27 (17%), 7 (5%), 69 (44%) and 54 (34%) patients, respectively. Twenty (13%) patients received guideline-directed PSA screening, 5/155 (3%) patients presented with metastases prior to age 55 with their first PSA, and 130/155 (84%) had their first PSA after age 55, of which 122/130 (94%) had metastasis at the time of diagnosis.


CONCLUSIONS
Despite widespread screening, most men treated for metastatic prostate cancer at our institution presented with metastases rather than progressed after definitive treatment. Furthermore, 25 (16%) patients received guideline-directed PSA screening at or before age 55. These data highlight that, despite mass screening efforts, patients treated for incurable disease at our institution may not have been a result of a failed screening test, but a failure to be screened.
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Philip A
PA
Fontenot
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Avinash
A
Nehra
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
William
W
Parker
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Hadley
H
Wyre
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Moben
M
Mirza
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
David A
DA
Duchene
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Jeffrey
J
Holzbeierlein
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
James Brantley
JB
Thrasher
Division of Hematology/Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Peter
P
Van Veldhuizen
Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Eugene K
EK
Lee
D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016019:Survival Analysis
D017430:Prostate-Specific Antigen
Neoplasms; Prostate; Prostate-Specific Antigen