{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:40:42Z","timestamp":1760150442637,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T00:00:00Z","timestamp":1701216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>To examine the impact of ultra-high iPSA levels of &gt;50 ng\/mL (uhPSA) after modern radiotherapy, we compared outcomes of 214 patients with uhPSA levels to 1161 other high-risk patients. Radiotherapy included brachytherapy \u00b1 external beam radiotherapy (EBRT) and EBRT alone (intensity-modulated radiotherapy or stereotactic body radiotherapy). The biochemical disease-free survival rate (bDFS), the distant metastasis-free survival rate (DMFS), local control, and pelvic lymph node control were analyzed. Patients with uhPSA levels had an inferior bDFS (84.8% at 5 years) and DMFS (93.9% at 5 years) compared to other high-risk patients (92.7% and 97.2%, both p &lt; 0.001). The uhPSA group showed more distant metastases than the non-uhPSA group; however, the frequencies of local failure and pelvic lymph node recurrence were similar. The uhPSA group demonstrated hazard ratios (HRs) of 2.74 for bDFS and 2.71 for DMFS, similar to those of T3b\u20134 (HR 2.805 and 2.678 for bDFS and DMFS) and GS 9\u201310 (HR 2.280 and 2.743 for bDFS and DMFS). An uhPSA level could be a candidate for a single VHR factor to identify high-risk patients who require intensified treatment.<\/jats:p>","DOI":"10.3390\/cancers15235644","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T12:01:00Z","timestamp":1701259260000},"page":"5644","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ultra-High Prostate-Specific Antigen Level: A Potential Very-High-Risk Factor for Localized High-Risk Prostate Cancer"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7508-7217","authenticated-orcid":false,"given":"Hideya","family":"Yamazaki","sequence":"first","affiliation":[{"name":"Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6018-468X","authenticated-orcid":false,"given":"Gen","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9208-1909","authenticated-orcid":false,"given":"Koji","family":"Masui","sequence":"additional","affiliation":[{"name":"Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Ueda","sequence":"additional","affiliation":[{"name":"Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takumi","family":"Shiraishi","sequence":"additional","affiliation":[{"name":"Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuko","family":"Fujihara","sequence":"additional","affiliation":[{"name":"Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ujitakeda Hospital, Uji-City 611-0021, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasutoshi","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ujitakeda Hospital, Uji-City 611-0021, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruumi","family":"Okabe","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ujitakeda Hospital, Uji-City 611-0021, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer Statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"(2023, February 28). The National Comprehensive Cancer Network (NCCN), NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer, 2023 version 1. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/prostate.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/pcan.2013.46","article-title":"Very-high-risk localized prostate cancer: Definition and outcomes","volume":"17","author":"Sundi","year":"2014","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.ijrobp.2010.02.034","article-title":"Impact of ultrahigh baseline PSA levels on biochemical and clinical outcomes in two Radiation Therapy Oncology Group prostate clinical trials","volume":"80","author":"Rodrigues","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e525","DOI":"10.1016\/j.ijrobp.2012.01.041","article-title":"Treatment outcomes in non-metastatic prostate cancer patients with ultra-high prostate-specific antigen","volume":"83","author":"Tai","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e713","DOI":"10.1016\/j.ijrobp.2010.11.068","article-title":"Extreme-risk prostate adenocarcinoma presenting with prostate-specific antigen (PSA)>40 ng\/mL: Prognostic significance of the preradiation PSA nadir","volume":"81","author":"Alexander","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s13014-016-0743-2","article-title":"Classifying high-risk versus very high-risk prostate cancer: Is it relevant to outcomes of conformal radiotherapy and androgen deprivation?","volume":"12","author":"Saad","year":"2017","journal-title":"Radiat. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/s00432-013-1426-0","article-title":"Radical radiotherapy in high-risk prostate cancer patients with high or ultra-high initial PSA levels: A single institution analysis","volume":"139","author":"Guarneri","year":"2013","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_9","unstructured":"(2020, January 23). An Open Data of Multicenter Data Collection: Outcome of Radiation Therapy for Prostate Cancer to Establish a Prognostic Prediction System by Machine Learning (B17\u2013278). Available online: https:\/\/www.khp.kitasato-u.ac.jp\/ska\/radiotherapy\/arcivements\/#results."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.brachy.2017.01.006","article-title":"Nationwide multi-institutional retrospective analysis of high-dose-rate brachytherapy combined with ex-ternal beam radiotherapy for localized prostate cancer: An Asian Prostate HDR-BT Consortium","volume":"16","author":"Ishiyama","year":"2017","journal-title":"Brachytherapy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13194","DOI":"10.1038\/s41598-021-92307-8","article-title":"Multi-institutional retrospective analysis of ultrahypofractionated radiotherapy for Japanese prostate cancer patients","volume":"11","author":"Ishiyama","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.brachy.2014.09.001","article-title":"Permanent prostate brachytherapy and short-term androgen deprivation for intermediate-risk prostate cancer in Japanese men: Outcome and toxicity","volume":"14","author":"Yamada","year":"2015","journal-title":"Brachytherapy"},{"key":"ref_13","first-page":"385","article-title":"Long-term Outcomes of a Dose-reduction Trial to Decrease Late Gastrointestinal Toxicity in Patients with Prostate Cancer Receiving Soft Tissue-matched Image-guided Intensity-modulated Radiotherapy","volume":"38","author":"Sasaki","year":"2018","journal-title":"Anticancer. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ijrobp.2015.10.056","article-title":"Very High-Risk Localized Prostate Cancer: Outcomes Following Definitive Radiation","volume":"94","author":"Narang","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/COC.0000000000000201","article-title":"Do Prostate Cancer Patients With Markedly Elevated PSA Benefit From Radiation Therapy?: A Population-based Study","volume":"40","author":"Lawrence","year":"2017","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/bju.12061","article-title":"The utility of prostate-specific antigen in the management of advanced prostate cancer","volume":"112","author":"Crawford","year":"2013","journal-title":"BJU Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"8815","DOI":"10.3390\/curroncol30100636","article-title":"Identification of Early Biochemical Recurrence Predictors in High-Risk Prostate Cancer Patients Treated with Carbon-Ion Radiotherapy and Androgen Deprivation Therapy","volume":"30","author":"Utsumi","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.eururo.2019.02.003","article-title":"Prostate Radiotherapy for Metastatic Hormone-sensitive Prostate Cancer: A STOPCAP Systematic Review and Meta-analysis","volume":"76","author":"Burdett","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1038\/s41391-021-00339-y","article-title":"Long-term outcomes of prostate radiotherapy for newly-diagnosed metastatic prostate cancer","volume":"24","author":"Morgan","year":"2021","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.eururo.2015.01.013","article-title":"Can Clinically Sinificant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature","volume":"68","author":"Briganti","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/S0140-6736(20)30314-7","article-title":"Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): A prospective, randomised, multicentre study","volume":"395","author":"Hofman","year":"2020","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1200\/JCO.20.02873","article-title":"Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients with Localized Prostate Cancer: Results from the FLAME Randomized Phase III Trial","volume":"39","author":"Kerkmeijer","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.ijrobp.2019.11.402","article-title":"Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: Efficacy and Toxicity in the DELINEATE Trial","volume":"106","author":"Murray","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.ijrobp.2022.09.058","article-title":"Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: 5-Year Efficacy and Toxicity in the DELINEATE Trial","volume":"115","author":"Tree","year":"2023","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S0140-6736(21)02437-5","article-title":"Systemic Therapy in Advancing or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) investigators. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: A meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol","volume":"399","author":"Attard","year":"2022","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"pkac043","DOI":"10.1093\/jncics\/pkac043","article-title":"Docetaxel for Nonmetastatic Prostate Cancer: Long-Term Survival Outcomes in the STAMPEDE Randomized Controlled Trial","volume":"6","author":"James","year":"2022","journal-title":"JNCI Cancer Spectr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41391-022-00598-3","article-title":"Second generation anti-androgens and androgen deprivation therapy with radiation therapy in the definitive management of high-risk prostate cancer","volume":"26","author":"Wang","year":"2023","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1111\/j.1464-410X.2006.06201.x","article-title":"Comparison of the clinical outcome after hormonal therapy for prostate cancer between Japanese and Caucasian men","volume":"97","author":"Fukagai","year":"2006","journal-title":"BJU Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.eururo.2014.09.028","article-title":"The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy","volume":"67","author":"Zumsteg","year":"2015","journal-title":"Eur. Urol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/23\/5644\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:33:56Z","timestamp":1760132036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/23\/5644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,29]]},"references-count":30,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["cancers15235644"],"URL":"https:\/\/doi.org\/10.3390\/cancers15235644","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2023,11,29]]}}}