Comparing overall survival in patients with metastatic prostate cancer using PSA levels: A multivariate analysis using a national database.

e17089 Background: Prostate - specific antigen (PSA) is a useful biomarker for detection of prostate cancer and for risk classification in addition to TNM classification and Gleason score. Data is limited in determining its role in prognostication. The purpose of our study is to learn the impact of PSA value at the time of diagnosis on overall survival in patients with de novo metastatic prostate cancer. Methods: The National Cancer Database (NCDB) 2016-17 was queried to identify all patients diagnosed with de novo metastatic prostate adenocarcinoma. The demographic and clinical characteristics were compared using Pearson’s chi-square test between patients with PSA<98 ng/mL versus >=98 ng/mL. A multivariate cox regression analysis was done to determine the survival difference between the two groups. Results: The NCDB database found a cohort of 18,157 patients with de novo metastatic prostate cancer. A total of 8593 patients had PSA values below 98, while 9564 patients had PSA levels equal to or above 98. Multivariate cox regression analysis was done, and results indicated HR of 1.11 with 95% CI 1.07-1.13 and p value <0.001, indicating 11% worse survival in patients with higher PSA. Patients were further stratified based on age, race, and sites of metastasis. The results were consistent across all groups, with a significant p-value of <0.001. Conclusions: Our study indicates that a higher PSA value at the time of diagnosis is associated with a lower overall survival in patients with de novo metastatic prostate cancer. Further prospective studies with potentially higher PSA thresholds are needed to validate this correlation. Should concordant results be obtained, this may suggest utilizing more aggressive treatment strategies in this subset of patients to improve clinical outcomes. [Table: see text]