{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T13:10:11Z","timestamp":1748783411658,"version":"3.41.0"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prior studies have concentrated exclusively on how different prostate\u2010specific antigen (PSA) levels affect the prognosis of high\u2010grade prostate cancer (PCa), often overlooking the prognosis of low\u2010grade PCa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The present cohort study included individuals diagnosed with PCa from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2021. The all\u2010cause mortality (ACM) and prostate cancer\u2010specific mortality (PCSM) for each treatment group was calculated stratified by the four PSA levels (\u2264\u20094.0, 4.1\u201310.0, 10.1\u201320.0, and &gt;\u200920.0\u2009ng\/mL). Fine and Gray competing\u2010risks analyses were conducted to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Cox proportional hazards regression analyses using PSA as a continuous variable with restricted cubic splines (RCS) were conducted to allow for potential nonlinear relationships.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study encompassed 416,825 male patients diagnosed with PCa. Compared to individuals with PSA value between 4.1 and 10.0\u2009ng\/mL, a significant association between low levels of PSA (\u2264\u20094.0\u2009ng\/mL) and an increased risk of ACM (AHR\u2009=\u20091.15, 95% CI: 1.12\u22121.19; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and PCSM (AHR\u2009=\u20091.49, 95% CI: 1.38\u22121.61; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) was observed. Additionally, the increased risk of ACM (AHR\u2009=\u20091.35, 95% CI: 1.29\u22121.40; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and PCSM (AHR\u2009=\u20091.84, 95% CI: 1.67\u22122.02; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) are more pronounced within the first 5 years post\u2010diagnosis. In most subgroups, similar results were observed. The RCS curves further corroborated the correlation between PSA value and the risk of mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Low PSA levels are notably linked to a heightened risk for both ACM and PCSM, irrespective of the grade of PCa being high or low. There is a need to initiate new studies that tackle novel diagnostics and therapeutics.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pros.24860","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T11:59:27Z","timestamp":1738151967000},"page":"580-593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reassessing the Role of Low PSA in Prognosis Across Grades of Prostate Cancer: A Cohort Study"],"prefix":"10.1002","volume":"85","author":[{"given":"Cheng","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Urology Affiliated Hospital 2 of Nantong University Nantong Jiangsu People's Republic of China"},{"name":"Institute of Urological Diseases, Nantong University Affiliated Hospital 2 of Nantong University Nantong Jiangsu People's Republic of 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Jiangsu People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong\u2010Shen","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Urology Affiliated Hospital 2 of Nantong University Nantong Jiangsu People's Republic of China"},{"name":"Institute of Urological Diseases, Nantong University Affiliated Hospital 2 of Nantong University Nantong Jiangsu People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Urology Affiliated Hospital 2 of Nantong University Nantong Jiangsu People's Republic of China"},{"name":"Institute of Urological Diseases, Nantong University Affiliated Hospital 2 of Nantong University Nantong Jiangsu People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Urology 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