Clinical significance of the prostate-specific antigen doubling time prior to and following radical prostatectomy to predict the outcome of prostate cancer

Abstract

Abstract. With the advent of serum prostate-specific antigen (PSA), a larger number of prostate cancers in the early phase have been successfully detected. Although decisions to perform prostate biopsies are routinely based on PSA levels, the PSA level is easily influenced by benign prostatic hyperplasia, with poor specificity. Therefore, the aim of the present study was to assess the clinical significance of prostatespecific antigen doubling time (PSADT) prior to and following radical prostatectomy. In total, 488 patients with T1c-3N0M0 prostate cancer who underwent radical prostatectomy were included. Preoperative and postoperative PSADT were retrospectively correlated with pathological and clinical outcomes. Preoperative PSADT was measured in 204 of the 488 patients. In total, 16 out of 20 patients with a preoperative PSADT of >24 months had a cancer confined to the prostate compared with 105 of 184 patients with a PSADT of <24 months. The PSA non-recurrence rate at 5 years for patients with a preoperative PSADT of >24 months was significantly better compared with those with a preoperative PSADT of <24 months (P= 0.011). Patients with a PSADT of >24 months and stable PSADT were associated with PSA recurrence following surgery, based on multivariate analysis. Postoperative PSADT was measured in 51 of 111 patients with PSA failure following surgery. Pathologically, 7 of 8 patients with a post-PSADT of >24 months had a cancer confined to the prostate compared with 14 of 43 patients with a post-PSADT of <24 months. These results suggest that patients with longer preoperative PSADTs appeared to have a favorable pathological result and a higher PSA non-recurrence rate compared with those with shorter preoperative PSADTs. A longer postoperative PSADT may facilitate the observation of patients with PSA recurrence without immediate secondary treatments.

<p>Prognostic significance of a novel indicator (PSA_postd3/PSA_pre) for PSA recurrence in patients after radical prostatectomy</p>

“…Commonly investigated indicators include the following. 1) Preoperative PSA: Most studies have concluded that a high level of preoperative PSA was associated with PSA recurrence,6,7,12–15 although Takeuchi16 and Aguilera17 reported insignificant results. Preoperative PSA doubling time (PSADT) has been a rising indicator in recent years, especially early PSADT and ultrasensitive PSADT, but their relationships with PSA recurrence are controversial 8.…”

“…2) Pathological Gleason score: Much evidence has supported that a higher Gleason score increases the risk of PSA recurrence,7,13–18 while a few studies have also reported insignificant results 12,19. 3) Pathological T stage: Generally, a higher T stage suggests a greater probability of developing PSA recurrence 7,12,14–16. 4) Age: According to Wang et al, patients older than 70 years old were less likely to undergo PSA recurrence than those who were younger,12 although most other studies have reported an insignificant relationship between age and PSA recurrence 7,14,16,20,21.…”

“…3) Pathological T stage: Generally, a higher T stage suggests a greater probability of developing PSA recurrence 7,12,14–16. 4) Age: According to Wang et al, patients older than 70 years old were less likely to undergo PSA recurrence than those who were younger,12 although most other studies have reported an insignificant relationship between age and PSA recurrence 7,14,16,20,21. 5) Positive surgical margin: The prognostic value of PSM has been controversial 7,14,15,17,19,20.…”

Decreased biochemical progression in patients with castration‑resistant prostate cancer using a novel mefenamic acid anti‑inflammatory therapy: A randomized controlled trial

“…PSA values at baseline and at 6 months of treatment were investigated for the mefenamic acid and placebo groups in the present study. According to the criteria of the Prostate Cancer Clinical Trials Working Group 3, this is a useful measurement to determine therapeutic efficacy and tumor progression in clinical trials (34,76).…”

Time to Prostate-Specific Antigen Nadir After Radical Prostatectomy – a new potential predictive prognostic parameter and its impact on clinical outcomes

“…(6) Pre-op PSA density, pre-op PSA velocity (PSAV) and pre and post-op PSA doubling time (PSADT) have also been shown to have prognostic value, however, none of these PSA metrics has reported a strong and consistent association with prostate cancerspecific mortality (PCSM). (7)(8)(9) Post-op PSAV and PSADT have not found widespread clinical favour as it is often necessary to wait for > 12 months for results which are problematic in view of the need to determine an (early) adjuvant therapy in recurrent disease. Previous studies have observed the lowest PSA level after RP (PSA nadir)…”