Prostate specific antigen velocity as a measure of the natural history of prostate cancer: defining a ‘rapid riser’ subset

Abstract

Objective To study the rate of change in prostate specific antigen (PSA velocity) in patients with prostate cancer initially managed by ‘watchful waiting’. Patients and methods Serial PSA levels were determined in 141 patients with prostate cancer confirmed by biopsy, who were initially managed expectantly and enrolled between May 1990 and December 1995. Sixty‐seven patients eventually underwent surgery (mean age 59 years) because they chose it (the decision for surgery was not based on PSA velocity). A cohort of 74 patients remained on ‘watchful waiting’ (mean age 69 years). Linear regression and logarithmic transformations were used to segregate those patients who showed a rapid rise, defined as a>50% rise in PSA per year (or a doubling time of <2 years) and designated ‘rapid risers’. Results An initial analysis based on a minimum of two PSA values showed that 31% were rapid risers. Only 15% of patients with more than three serial PSA determinations over ≥6 months showed a rapid rise in PSA level. There was no advantage of log‐linear analysis over linear regression models. Conclusion Three serial PSA determinations over ≥6 months in patients with clinically localized prostate cancer identifies a subset (15%) of patients with a rapidly rising PSA level. Shorter PSA surveillance with fewer PSA values may falsely identify patients with rapid rises in PSA level. However, further follow‐up is required to determine if a rapid rise in PSA level identifies a subset of patients with an aggressive biological phenotype who are either still curable or who have already progressed to incurability through metastatic disease.

Wide variation of prostate‐specific antigen doubling time of untreated, clinically localized, low‐to‐intermediate grade, prostate carcinoma

“…However, others [5,6,10] reported no correlation between T d and any other variables, including clinical stage. Schmid et al [7] reported in a series of 43 patients that there was a statistically significant relationship between a Gleason score of £ 6 vs ≥ 7 and T d of > 24 vs £ 24 months ( P = 0.05).…”

“…The median (range) follow-up of the cohort was 45 (6-85) months and the median number of PSA measurements for calculating T d was 8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The distribution of the frequency of PSA measurements was 3-5 in The distribution of l and the corresponding T d for the 231 patients is shown in Table 3; the median (range) T d was 7.0 (0.51-infinity).…”

Use of pretreatment prostate-specific antigen doubling time to predict outcome after radical prostatectomy

“…It has been speculated that tumors with relatively stable or declining PSA levels may be in their linear phase of growth and may safely be followed for years without treatment. 6,8,17, Conversely, tumors with rapidly increasing PSA levels may be in the exponential growth phase and thus signi®cant. The median calculated PSA doubling time in patients with increasing levels was 25.8 months in this study.…”

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

“…Previous studies on PSA kinetics, such as the PSA doubling time (PSADT), PSA slope, and PSA velocity (2)(3)(4), have indicated that these may provide valuable information for diagnosis and staging. The estimation of PSA kinetics, such as PSADT, is not difficult; however, finding an important enough reason to wait for >3 months to measure PSADT for staging prior to making a decision regarding the treatment strategy is difficult.…”

“…The estimation of PSA kinetics, such as PSADT, is not difficult; however, finding an important enough reason to wait for >3 months to measure PSADT for staging prior to making a decision regarding the treatment strategy is difficult. Additionally, the prognostic values with respect to PSA recurrence and cancer-specific mortality remain controversial (3)(4)(5)(6)(7).…”