Systematic Review of Pretreatment Prostate-Specific Antigen Velocity and Doubling Time As Predictors for Prostate Cancer

Vickers, Andrew J.; Savage, Caroline; O’Brien, Marie; Lilja, Hans

doi:10.1200/jco.2008.18.1685

Cited by 220 publications

(138 citation statements)

References 26 publications

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“…It demonstrates sensitivity but lacks specificity. 14 We previously reported that in 300 men who remained on surveillance long term, none of whom had clinical or pathologic progression, 50% had at least one trigger for intervention at some point during the follow-up period. 15 Therefore, relying on PSA kinetics to determine who to treat would result in significant overtreatment.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer

Klotz

Vesprini

Sethukavalan

et al. 2015

JCO

1,009

783

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Purpose Active surveillance is increasingly accepted as a treatment option for favorable-risk prostate cancer. Long-term follow-up has been lacking. In this study, we report the long-term outcome of a large active surveillance protocol in men with favorable-risk prostate cancer. Patients and Methods In a prospective single-arm cohort study carried out at a single academic health sciences center, 993 men with favorable- or intermediate-risk prostate cancer were managed with an initial expectant approach. Intervention was offered for a prostate-specific antigen (PSA) doubling time of less than 3 years, Gleason score progression, or unequivocal clinical progression. Main outcome measures were overall and disease-specific survival, rate of treatment, and PSA failure rate in the treated patients. Results Among the 819 survivors, the median follow-up time from the first biopsy is 6.4 years (range, 0.2 to 19.8 years). One hundred forty-nine (15%) of 993 patients died, and 844 patients are alive (censored rate, 85.0%). There were 15 deaths (1.5%) from prostate cancer. The 10- and 15-year actuarial cause-specific survival rates were 98.1% and 94.3%, respectively. An additional 13 patients (1.3%) developed metastatic disease and are alive with confirmed metastases (n = 9) or have died of other causes (n = 4). At 5, 10, and 15 years, 75.7%, 63.5%, and 55.0% of patients remained untreated and on surveillance. The cumulative hazard ratio for nonprostate-to-prostate cancer mortality was 9.2:1. Conclusion Active surveillance for favorable-risk prostate cancer is feasible and seems safe in the 15-year time frame. In our cohort, 2.8% of patients have developed metastatic disease, and 1.5% have died of prostate cancer. This mortality rate is consistent with expected mortality in favorable-risk patients managed with initial definitive intervention.

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Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer

Klotz

Vesprini

Sethukavalan

et al. 2015

JCO

1,009

783

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“…Moreover, recent reports have questioned its role in PC detection. There is little evidence showing that calculation of PSA velocity in untreated patients provides predictive information beyond that provided by absolute PSA level alone (28,29).…”

Section: Psa Velocity and Psa Doubling Timementioning

confidence: 99%

Prostatic specific antigen for prostate cancer detection

Nogueira¹,

Corradi²,

Eastham³

2009

Int. braz j urol.

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Prostate-specific antigen (PSA) has been used for prostate cancer detection since 1994. PSA testing has revolutionized our ability to diagnose, treat, and follow-up patients. In the last two decades, PSA screening has led to a substantial increase in the incidence of prostate cancer (PC). This increased detection caused the incidence of advanced-stage disease to decrease at a dramatic rate, and most newly diagnosed PC today are localized tumors with a high probability of cure. PSA screening is associated with a 75% reduction in the proportion of men who now present with metastatic disease and a 32.5% reduction in the age-adjusted prostate cancer mortality rate through 2003. Although PSA is not a perfect marker, PSA testing has limited specificity for prostate cancer detection, and its appropriate clinical application remains a topic of debate. Due to its widespread use and increased over-detection, the result has been the occurrence of over-treatment of indolent cancers. Accordingly, several variations as regards PSA measurement have emerged as useful adjuncts for prostate cancer screening. These procedures take into consideration additional factors, such as the proportion of different PSA isoforms (free PSA, complexed PSA, pro-PSA and B PSA), the prostate volume (PSA density), and the rate of change in PSA levels over time (PSA velocity or PSA doubling time). The history and evidence underlying each of these parameters are reviewed in the following article.

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“…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]. Our own experience was that, in the stable, untreated patients in our cohort a "false PSA trigger" for intervention occurred in up to 50% [27].…”

Section: Triggers For Interventionmentioning

confidence: 67%

Active Surveillance for Low-Risk Prostate Cancer

Klotz

2015

Curr Urol Rep

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Systematic Review of Pretreatment Prostate-Specific Antigen Velocity and Doubling Time As Predictors for Prostate Cancer

Cited by 220 publications

References 26 publications

Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer

Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer

Prostatic specific antigen for prostate cancer detection

Active Surveillance for Low-Risk Prostate Cancer

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