Clinicopathological Profiles and Outcomes of Low vs High PSA Metastatic Prostate Adenocarcinoma: a Retrospective Study from a Single Tertiary Care Centre in South India.

[UNLABELLED] Metastatic carcinoma prostate with low serum prostate-specific antigen (PSA < 10 ng/ml) is usually poorly differentiated and has poor overall survival. This study aims to compare the clinicopathological profile and oncological outcomes between treatment-naïve metastatic carcinoma prostate with low PSA (< 10 ng/ml) and high PSA (> 10 ng/ml) at presentation. Data were collected retrospectively from the hospital's database from January 2005 to December 2017. All treatment-naïve metastatic adenocarcinoma prostate cases with PSA < 10 ng/dl were included ( = 27), excluding one patient with prostatic rhabdomyosarcoma. Age-matched controls (± 2 years) in a 1 case:2 controls ratio were selected ( = 54). Patients were followed with PSA at 3, 6, and 12 months, and at the last follow-up. Most patients in both groups presented with lower urinary tract symptoms (LUTS). Neuroendocrine differentiation was more common in the low PSA group. The pattern of bone metastasis was similar in both groups. A higher percentage of patients (79.6%) in the high PSA group progressed to castration-resistant prostate cancer (CRPC) compared to 50% in the low PSA group, though the median time to CRPC was similar. In conclusion, the mode of presentation and pattern of metastasis were similar in both groups. Neuroendocrine histology was higher in the low PSA group (18.5% vs. 1.85%). No difference was observed in the time to CRPC between the two groups, though this interpretation should be cautious due to limited follow-up cross-sectional imaging.

[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1007/s13193-024-02157-9.