Evaluation of prediagnostic prostate‐specific antigen dynamics as predictors of death from prostate cancer in patients treated conservatively

Abstract

Prostate‐specific antigen (PSA) dynamics have been proposed to predict outcome in men with prostate cancer. We assessed the value of PSA velocity (PSAV) and PSA doubling time (PSADT) for predicting prostate cancer‐specific mortality (PCSM) in men with clinically localized prostate cancer undergoing conservative management or early hormonal therapy. From 1990 to 1996, 2,333 patients were identified, of whom 594 had two or more PSA values before diagnosis. We examined 12 definitions for PSADT and 10 for PSAV. Because each definition required PSA measurements at particular intervals, the number of patients eligible for each definition varied from 40 to 594 and number of events from 10 to 119. Four PSAV definitions, but no PSADT, were significantly associated with PCSM after adjustment for PSA in multivariable Cox proportional hazards regression. All four could be calculated only for a proportion of events, and the enhancements in predictive accuracy associated with PSAV had very wide confidence intervals. There was no clear benefit of PSAV in men with low PSA and Gleason grade 6 or less. Although evidence that certain PSAV definitions help to predict PCSM in the cohort exist, the value of incorporating PSAV in predictive models to assist in determining eligibility for conservative management is, at best, uncertain.

Systematic Review and Meta-analysis of Factors Determining Change to Radical Treatment in Active Surveillance for Localized Prostate Cancer

“…Higher baseline PSA and T stage were associated with a higher rate of change to radical treatment. PSA changes (including PSADT and PSAv) also led to many changes in treatment, although evidence of the validity of PSA as a measure of disease progression is lacking [45][46][47][48]. There was no evidence that any PSA eligibility criteria, frequency of PSA testing, or adoption of PSA triggers for treatment change were associated with rate of treatment change among studies, and only weak evidence that less mature studies had a higher rate of change.…”

Four‐year outcomes from a multiparametric magnetic resonance imaging (MRI)‐based active surveillance programme: PSA dynamics and serial MRI scans allow omission of protocol biopsies

“…). We accept that PSA dynamics may not be predictive of long‐term prostate cancer‐specific mortality in men on active surveillance . We believe that PSA velocity can be used specifically to select men on active surveillance with negative MRI for further investigation and is complementary to a holistic clinical assessment in this circumstance.…”

Prostate‐specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer

“…The role of PSA kinetics in the management of PCa has been investigated in numerous situations. PSAdt before diagnosis has been shown not to predict PCa mortality or progression on re‐biopsy in patients managed by AS ; however, PSAdt values obtained before RP have been shown to predict PCa‐specific mortality and survival in patients with castrate‐resistant PCa . In patients managed by watchful waiting in the SPCG‐4 study, a short PSAdt was associated with an increased relative risk of lethal PCa , but among men with a PSAdt of 3–10 years there was a cumulative incidence of lethal PCa after 6 years of 7–9%.…”

“…Most AS programmes use a combination of repeated biopsies (rebiopsy), PSA kinetics and clinical tumour category (cT) to assess patients . A recent study has questioned the ability of PSA doubling time (PSAdt) to identify patients with clinically significant PCa, as it found no correlation between prediagnostic PSAdt and PCa‐specific mortality in patients treated conservatively .…”