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British Journal of Urology
Article . 2025 . Peer-reviewed
License: CC BY NC ND
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Percentage of free to total PSA as a biomarker of survival in metastatic castration‐resistant prostate cancer

Authors: Andrew W. Silagy; Dixon T.S. Woon; Louise Kostos; Rui Bernardino; Ting W. Yiu; Marian S. Wettstein; Hanan Goldberg; +7 Authors

Percentage of free to total PSA as a biomarker of survival in metastatic castration‐resistant prostate cancer

Abstract

Objective To analyse whether the percentage of free to total prostate‐specific antigen (%fPSA) is a prognostic biomarker in metastatic castration‐resistant prostate cancer (mCRPC), as novel studies suggest an elevated %fPSA is associated with adverse oncological outcomes for men with biochemical recurrence of prostate cancer. Patients and Methods A biobank prospectively collated at mCRPC diagnosis was analysed for %fPSA. Clinicopathological characteristics, systemic therapies and survival outcomes were recorded. Patients were stratified by a %fPSA cut‐off of 15%. Cox proportional hazard models evaluated whether %fPSA was associated with overall survival (OS) and cancer‐specific survival (CSS) across the cohort and by treatment. Results A total of 254 patients analysed with newly diagnosed mCRPC: 161 (63%) men having a %fPSA ≥15%. The median follow‐up was 25.6 months. The median cohort OS and CSS was 39.6 and 43.8 months, respectively. Patients with a %fPSA ≥15% had lower median PSA level (31.30 vs 50.80 ng/mL; P = 0.007) and otherwise comparable clinicopathological and treatment profiles to men with a %fPSA <15%. Adjusting for PSA and on multivariable analysis, a %fPSA ≥15% was associated with shorter OS (multivariable hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.02–2.40; P = 0.039). Among men treated with docetaxel, a %fPSA ≥15% was associated with worse OS (HR 1.84, 95% CI 1.03–3.26; P = 0.038) and CSS. Conversely, %fPSA was not associated with outcomes for men receiving androgen receptor pathway inhibitors (abiraterone acetate or enzalutamide). Conclusion An elevated %fPSA appears to be an adverse prognostic biomarker. Findings are consistent with biochemical recurrence studies, suggesting a biological basis. Validation and mechanistic studies are warranted.

Keywords

Male, Aged, 80 and over, Prostatic Neoplasms, Castration-Resistant, Biomarkers, Tumor, Humans, Original Article, Prospective Studies, Prostate-Specific Antigen, Middle Aged, Neoplasm Metastasis, Prognosis, Aged

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
Average
Average
Average
Green
hybrid
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