Day to day changes in free and total PSA: significance of biological variation

Rg, Nixon; Wener, M. H.; Smith, Kenneth J.; Parson, RE; Blase, AB; Mk, Brawer

doi:10.1038/sj.pcan.4500212

Cited by 21 publications

(13 citation statements)

References 7 publications

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“…Nixon et al calculated the coefficient of variation over 2 weeks and demonstrated that a change between two total PSA measurements of approximately 25% indicated a significant change. [31, 32] Bunting et al reported a critical difference, defined as the minimum percent change between two consecutive measurements that suggests a significant change beyond the normal variation, close to 60% over a time period of 1 year. [33] Bruun et al recently assessed the long-term variability of the different forms of PSA at several different total PSA levels in a randomly selected population of asymptomatic and apparently healthy men whose total PSA levels were <2.0 ng/mL at the end of the 8-year observation period.…”

Section: Total Psa and Its Limitationsmentioning

confidence: 99%

Tumor markers in prostate cancer I: Blood-based markers

Semjonow²,

et al. 2011

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INTRODUCTION The introduction of total prostate specific antigen (total PSA) testing in blood has revolutionized the detection and management of men with prostate cancer (PCa). The objective of this review was to discuss the challenges of PCa biomarker research, definition of the type of PCa biomarkers, the statistical considerations for biomarker discovery and validation, and to review the literature regarding total PSA velocity and novel blood-based biomarkers. METHODS An English-language literature review of the Medline database (1990 to August 2010) of published data on blood-based biomarkers and PCa was undertaken. RESULTS The inherent biological variability of total PSA levels affects the interpretation of any single result. Men who will eventually develop PCa have increased total PSA levels years or decades before the cancer is diagnosed. Total PSA velocity improves predictiveness of total PSA only marginally, limiting its value for PCa screening and prognostication. The combination of PSA molecular forms and other biomarkers improve PCa detection substantially. Several novel blood-based biomarkers such as human glandular kallikrein 2 (hK2), urokinase plasminogen activator (uPA) and its receptor (uPAR), transforming growth factor-beta 1 (TGF-β1); interleukin-6 (IL-6) and its receptor (IL-6R) may help PCa diagnosis, staging, prognostication, and monitoring. Panels of biomarkers that capture the biologic potential of PCa are in the process of being validated for PCa prognostication. CONCLUSIONS PSA is a strong prognostic marker for long-term risk of clinically relevant cancer. However, there is a need for novel biomarkers that aid clinical decision making about biopsy and initial treatment. There is no doubt that progress will continue based on the integrated collaboration of researchers, clinicians and biomedical firms.

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Section: Total Psa and Its Limitationsmentioning

confidence: 99%

Tumor markers in prostate cancer I: Blood-based markers

Semjonow²,

et al. 2011

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“…Por su parte, The Nacional Cancer Institute define el cribado con PSA como una estrategia que continua en fase de investigación 26 . Las principales razones que alegan sus detractores para desaconsejar el empleo del cribado con PSA son: la elevada tasa de sobrediagnóstico asociado al cribado (definido como aquellos pacientes diagnosticados de CP que no desarrollarían síntomas clínicos a lo largo de Incremento anual > 42% y dPSA > 0,15 ng/mL 48 88, 9 (62,8-99,9) 58,3 (36,5-80,1) 93, 3 (77,4-99,9) 44,4 (18,7-70,2) 41,7 (19,5) Incremento anual > 42% e IPSA < 15% 33 90,0 (66, 9) 65,9 (50,1-81,6) 96,4 (87, 9) 39,1 (17,0-61,3) 34,1 (18,9) Al menos 2 de 3 criterios: 59 55,6 (17,5-93,6) 88, 9 (71,6-99,9) 80,0 (60,0-99, 9) 71,4 (30,9) 11,1 (0,1-28,4)…”

Section: Discussionunclassified

“…Una de las principales aplicaciones de los datos de variación biológica es la estimación del valor de referencia del cambio (VRC), el cual proporciona información sobre cual es el cambio mínimo necesario para que las diferencias entre dos resultados consecutivos de un individuo sean consideradas clínicamente significativas 16,17 . La naturaleza de la variación biológica del PSA total ha sido ampliamente estudiada por numerosos autores [18][19][20][21] , encontrándose en las bases de datos internacionales de variación biológica 22 . Sin embargo, su utilización rutinaria está muy poco extendida, aún cuando el empleo del VRC podría ser una herramienta altamente eficaz para la adecuada interpretación de los cambios en la concentración de PSA a lo largo del tiempo y reducir de este modo el número de pacientes sometidos a biopsias innecesarias.…”

Section: Introductionunclassified

Valor de referencia del cambio del PSA en la evaluación del riesgo de cáncer de próstata

Arboleya

Arroyo

Obaya

2011

Revista del Laboratorio Clínico

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“…Intra-individual PSA variability, even when PSA is measured in the same laboratory, is now established [3]. The studies by Nixon et al [7,8] showed that before a change in PSA level could be ascribed to a real prostatic disease process, there must be a 25% increase. This calculation takes into account biological variation and laboratory issues.…”

Section: Discussionmentioning

confidence: 99%

Fluctuating prostate‐specific antigen levels in patients with initial negative biopsy: should we be reassured?

et al. 2007

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OBJECTIVE To evaluate whether the risk of having a positive repeat prostate biopsy is lower in patients with fluctuating prostate‐specific antigen (PSA) levels than in patients with a steady or steadily increasing PSA level. PATIENTS AND METHODS Files were extracted from the 2000–2003 databases of two teaching hospitals; 191 patients who had a first negative biopsy followed by one or more sets of biopsies and at least two PSA measurements were included. A ‘fluctuating PSA level’ in a patient was defined as a PSA series including at least one PSA value lower than the one immediately preceding it. RESULTS The median PSA level at the first biopsy was 7 ng/mL, while that for the second, third and fourth biopsies were 8.0, 8.0 and 8.7 ng/mL, respectively. The median time between the first and second, and the second and third PSA tests was 290 and 317 days, respectively. Prostate cancer was eventually detected in 53 men (27.7%) in whom 39 it was at the first repeat biopsy. Among the 79 patients with a fluctuating PSA level, 17 (22%) had prostate cancer, vs 36 (32%) among the 112 with a ‘steady’ PSA level; the difference was not significant (P = 0.14). When considering the 53 patients diagnosed with prostate cancer, the 17 with a fluctuating PSA level and the 36 others had no significant difference in age, T stage, first PSA level and Gleason score. CONCLUSION In the present study, by contrast with the common and unfounded view, the risk of having a positive repeat prostate biopsy was no lower in men with a fluctuating PSA level than in those with a steady or steadily increasing PSA level. The practical and economical implications warrant further studies to confirm these findings.

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Day to day changes in free and total PSA: significance of biological variation

Cited by 21 publications

References 7 publications

Tumor markers in prostate cancer I: Blood-based markers

Tumor markers in prostate cancer I: Blood-based markers

Valor de referencia del cambio del PSA en la evaluación del riesgo de cáncer de próstata

Fluctuating prostate‐specific antigen levels in patients with initial negative biopsy: should we be reassured?

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