Prostate-Specific Antigen Kinetics During Follow-Up Are an Unreliable Trigger for Intervention in a Prostate Cancer Surveillance Program

Ross, Ashley E.; Loeb, Stacy; Landis, Patricia; Partin, Alan W.; Epstein, Jonathan I.; Kettermann, Anna; Feng, Zhaoyong; Carter, H. Ballentine; Walsh, Patrick C.

doi:10.1200/jco.2009.25.7311

Cited by 236 publications

(175 citation statements)

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“…Although men from this cohort already selected for treatment were not included in this analysis, it does suggest that PSA kinetics are not static, and single PSA trigger points should be interpreted carefully. Further questioning the role of PSA changes over time for men on AS, the Johns Hopkins group showed no correlation between PSA DT and adverse pathology at surveillance biopsy or RP for those who eventually underwent surgical management [42]. Similarly, within the UCSF cohort, little concordance was found between PSAV and biopsy progression [43].…”

Section: 5mentioning

confidence: 99%

Active Surveillance for Prostate Cancer: A Systematic Review of the Literature

et al. 2012

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Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Prostate cancer (PCa) remains an increasingly common malignancy worldwide. The optimal management of clinically localized, early-stage disease remains unknown, and profound quality of life issues surround PCa interventions. Objective: To systematically summarize the current literature on the management of low-risk PCa with active surveillance (AS), with a focus on patient selection, outcomes, and future research needs.

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Section: 5mentioning

confidence: 99%

Active Surveillance for Prostate Cancer: A Systematic Review of the Literature

et al. 2012

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“…For example, Ross et al analyzed the association between PSA kinetics and biopsy progression in a group of 290 men managed with AS at their institution. 5 Over a median follow-up period of 2.9 years, 35% of these men developed biopsy progression. The authors were not able to find any PSAV or PSADT cut-points with both high sensitivity and specificity for biopsy progression.…”

Section: Discussionmentioning

confidence: 99%

“…Candidates for AS are likely to have a large prostate as a result of inclusion criteria regarding PSA density, and anterior tumors are often missed. 4 Furthermore, rebiopsy is associated with complications and mental distress, 5 and is thus a serious problem for both patients and physicians alike. 1 More reliable and less invasive methods are required for favorable outcomes after AS.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Most of these studies did not show a significant association. 5,6 Given the limited duration of follow up in most contemporary AS cohorts, this could have been caused by a relatively small number of measurements carried out over a short period of time, as the reliability of PSA kinetics is known to increase over longer time-periods. 7 To address these gaps, we analyzed the association between prediagnostic PSA kinetics and the risk of biopsy progression in our AS cohort, and also studied the effect of adding prediagnostic PSA values to post-diagnostic PSA values on the predictive performance of PSAV and PSADT.…”

Section: Introductionmentioning

confidence: 99%

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Prediagnostic prostate‐specific antigen kinetics and the risk of biopsy progression in active surveillance patients

et al. 2016

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Abbreviations & Acronyms AS = active surveillance IQR = interquartile range PSA = prostate-specific antigen PSADT = prostate-specific antigen doubling time PSAV = prostate-specific antigen velocity Objective: To analyze the association between prediagnostic prostate-specific antigen kinetics and the risk of biopsy progression in prostate cancer patients on active surveillance, and to study the effect of prediagnostic prostate-specific antigen values on the predictive performance of prostate-specific antigen velocity and prostate-specific antigen doubling time. Methods: The study included 137 active surveillance patients with two or more prediagnostic prostate-specific antigen levels measured over a period of at least 3 months. Two sets of analyses were carried out. First, the association between prostate-specific antigen kinetics calculated using only the prediagnostic prostate-specific antigen values and the risk of biopsy progression was studied. Second, using the same cohort of patients, the predictive value of prostate-specific antigen kinetics calculated using only post-diagnostic prostate-specific antigens and compared with that of prostatespecific antigen kinetics based on both pre-and post-diagnostic prostate-specific antigen levels was analyzed. Results: Of 137 patients included in the analysis, 37 (27%) had biopsy progression over a median follow-up period of 3.2 years. Prediagnostic prostate-specific antigen velocity of more than 2 ng/mL/year and 3 ng/mL/year was statistically significantly associated with the risk of future biopsy progression. However, after adjustment for baseline prostate-specific antigen density, these associations were no longer significant. None of the tested prostate-specific antigen kinetics based on combined pre-and post-diagnostic prostate-specific antigen values were statistically significantly associated with the risk of biopsy progression. Conclusions: Historical prediagnostic prostate-specific antigens seems to be not clinically useful in patients diagnosed with low-risk prostate cancer on active surveillance.

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“…In the Toronto cohort, 100% of patients who have progressed to metastatic disease have had a PSA doubling time < 2 years. However, some recent studies have questioned the correlation between PSA kinetics and adverse disease characteristics [25]. A recent overview of this subject concluded that PSA kinetics, although predictive, did not add predictive value to absolute PSA, and should not be used for decision making in localized prostate cancer [26].…”

Section: Triggers For Interventionmentioning

confidence: 99%