Pretreatment Prostate-Specific Antigen (PSA) Velocity and Doubling Time Are Associated With Outcome but Neither Improves Prediction of Outcome Beyond Pretreatment PSA Alone in Patients Treated With Radical Prostatectomy

O’Brien, Marie; Cronin, Angel M.; Fearn, Paul; Smith, Brandon; Stasi, Jason; Guillonneau, Bertrand; Scardino, Peter T.; Eastham, James A.; Vickers, Andrew J.; Lilja, Hans

doi:10.1200/jco.2008.19.9794

Cited by 86 publications

(69 citation statements)

References 30 publications

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“…Several studies have shown that men with rapidly increasing PSAVs are at a higher risk of developing prostate cancer than those with low PSAV. 38 -42 As pointed out by O'Brien et al, 41 most of these reports had deficiencies. Firstly, in many of the studies, it was assumed that men who were not biopsied had no cancer.…”

Section: Psa Velocitymentioning

confidence: 99%

“…In an attempt to address this latter point, O'Brien et al 41 carried out a systematic review of the literature on studies relating PSAV to prostate cancer risk. Based on a review of 64 studies identified, the authors concluded that there was little evidence that measurement of PSAV in untreated men provided predictive information beyond that available from PSA alone.…”

Section: Psa Velocitymentioning

confidence: 99%

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Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

Duffy

2011

Ann Clin Biochem

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Although widely used, the value of prostate-specific antigen (PSA) in screening asymptomatic men for prostate cancer is controversial. Reasons for the controversy relate to PSA being less than an ideal marker in detecting early prostate cancer, the possibility that screening for prostate cancer may result in the overdetection and thus overtreatment of indolent disease and the lack of clarity as to the definitive or best treatment for men diagnosed with localized prostate cancer. Although the results from some randomized prospective trials suggest that screening with PSA reduces mortality from prostate cancer, the overall benefit was modest. It is thus currently unclear as to whether the modest benefit of reduced mortality outweighs the harms of overdetection and overtreatment. Thus, prior to undergoing screening for prostate cancer, men should be informed of the risks and benefits of early detection. Newly emerging markers that may complement PSA in the early detection of prostate cancer include specific isoforms of PSA and PCA3.

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Section: Psa Velocitymentioning

confidence: 99%

Section: Psa Velocitymentioning

confidence: 99%

Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

Duffy

2011

Ann Clin Biochem

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“…BCR was defined as PSA 0.1 ng/ml or greater with 1 confirmatory increase. 14 ADT was discussed with the patient and individually administered at treating physician discretion. Patients were followed with physical examination and PSA measurement every 3 months during year 1 after surgery, every 6 months during years 2 and 3, and annually thereafter.…”

Section: Methodsmentioning

confidence: 99%

660 Predicting Biochemical Recurrence Free Survival in Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

et al. 2010

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Purpose-We evaluated predictors of freedom from biochemical recurrence in patients with pelvic lymph node metastasis at radical prostatectomy.Materials and Methods-Of 207 patients with lymph node metastasis treated with radical prostatectomy and bilateral pelvic lymph node dissection 45 received adjuvant androgen deprivation therapy and 162 did not. Cox proportional hazards regression models were used to investigate predictors of biochemical recurrence after radical prostatectomy. Recurrence probability was estimated using the Kaplan-Meier method.Results-A median of 13 lymph nodes were removed. Of the patients 122 had 1, 44 had 2 and 41 had 3 or greater positive lymph nodes. Of patients without androgen deprivation therapy 103 had 1, 35 had 2 and 24 had 3 or greater positive lymph nodes while 69 experienced biochemical recurrence. Median time to recurrence in patients with 1, 2 and 3 or greater lymph nodes was 59, 13 and 3 months, respectively. Only specimen Gleason score and the number of positive lymph nodes were independent predictors of biochemical recurrence. Recurrence-free probability 2 years after prostatectomy in men without androgen deprivation with 1 positive lymph node and a prostatectomy Gleason score of 7 or less was 79% vs 29% in those with Gleason score 8 or greater and 2 or more positive lymph nodes.Conclusions-Prognosis in patients with lymph node metastasis depends on the number of positive lymph nodes and primary tumor Gleason grade. Of all patients with lymph node metastasis 80% had 1 or 2 positive nodes. A large subset of those patients had a favorable prognosis. Full bilateral pelvic lymph node dissection should be done in patients with intermediate and high risk cancer to identify those likely to benefit from metastatic node removal. Keywordsprostate; prostatic neoplasms; lymph node excision; neoplasm metastasis; prognosis The role of pelvic LN dissection and treatment in patients with LN metastasis after RP remain controversial. The risk of LN metastasis in men who undergo RP for clinically localized prostate cancer is 3% to 24%. [1][2][3][4][5][6] Patients with positive LNs at RP can have different outcomes. Some men never achieve undetectable PSA while others remain free of BCR for prolonged periods. Consequently ideal management for positive LNs at RP is In all treated patients RP was done contemporaneously with our study. Frozen sections were not routinely used. All RP specimens were serially sectioned at 3 to 5 mm, entirely submitted for permanent section and examined on whole mount slides. All LN specimens were sent en bloc for permanent section pathological analysis. After fixation in 10% neutral buffered formalin the LNs were meticulously dissected and counted manually by the pathologists. Each identified LN was cut when appropriate, embedded in paraffin, sectioned at 5 µm, stained with hematoxylin and eosin, and examined microscopically. No immunohistochemical staining for keratin or PSA and no reverse transcriptase-polymerase chain reaction technology was used. Residual...

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“…On the one hand, PSA velocity analysis may not be practical because multiple PSA values must be obtained over a period of years to use this algorithm most effectively 22 . Prospective studies have shown that these measurements do not provide additional information compared to PSA alone 23 .…”

Section: Psa Velocitymentioning

confidence: 99%

Prostate Specific Antigen. Current clinical application and future prospects

Duskova¹,

Veselý²

2015

BIOMED PAP

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Pretreatment Prostate-Specific Antigen (PSA) Velocity and Doubling Time Are Associated With Outcome but Neither Improves Prediction of Outcome Beyond Pretreatment PSA Alone in Patients Treated With Radical Prostatectomy

Cited by 86 publications

References 30 publications

Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

660 Predicting Biochemical Recurrence Free Survival in Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

Prostate Specific Antigen. Current clinical application and future prospects

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