Periodically, some of the men in one of my support groups get locked into what they see as the importance of monitoring their C-reactive protein (CRP) serum levels to be able to predict their chances of having a Bio-Chemical Recurrence (BCR) (PSA only). The CRP measures levels of inflammation and we know that inflammation and cancer go hand-in-hand.
In response to this type of concern, researchers have formally assessed the prognostic value of CRP serum levels for the prognostication of BCR after radical prostatectomy (RP) in a large multi-institutional cohort. They used data from 7205 men treated with RP at five institutions for clinically localized prostate cancer (PCa). In this retrospectively analyzed study preoperative serum levels of CRP within 24?h before surgery were evaluated. A CRP level greater than 0.5?mg?dl was considered elevated.
They then performed statistical evaluations of the association of elevated CRP with BCR.
The researchers found that men with higher Gleason score on biopsy and RP, extra-capsular extension, seminal vesicle invasion, lymph node metastasis, and positive surgical margins status had a significantly elevated preoperative CRP compared to those without these features. The men with an elevated CRP had a lower 5-year BCR survival proportion as compared to those with normal CRP.
They also found that elevated CRP was independently associated with BCR However, the addition of preoperative CRP did not improve the accuracy of the standard pre and postoperative models for the prediction of having a BCR.
The proper conclusion is that preoperative CRP elevation is common in men with pathological features of aggressive PCa and BCR after RP. It is true that CRP is an independent prognostic value; but it does not serve to add either prognostic or clinically significant information to standard predictors of outcomes.