Premium
Prostate‐specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer
Author(s) -
Thomsen Frederik Birkebæk,
Christensen Ib Jarle,
Brasso Klaus,
Røder Martin Andreas,
Iversen Peter
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12367
Subject(s) - medicine , prostate cancer , prostatectomy , prostate specific antigen , urology , confidence interval , prostate , biopsy , histopathology , cancer , doubling time , oncology , gynecology , pathology , biochemistry , chemistry , in vitro
Objectives To elucidate the role of prostate‐specific antigen ( PSA ) doubling time ( PSA dt) as a progression criterion in patients with low‐risk prostate cancer managed by active surveillance ( AS ). To assess the correlation between PSA dt during AS and final histopathology after radical prostatectomy ( RP ) in patients meeting predefined progression criteria.Patients and MethodsA total of 258 consecutive patients on an AS programme were included in the study. The PSA dt was calculated in patients with two or more PSA values, and 95% confidence intervals ( CIs ) were calculated in patients with four or more PSA values. Progression risk groups were defined as follows: high‐risk: PSA dt <3 years, rebiopsy G leason score ( GS ) ≥4 + 3, more than three positive biopsy cores, and/or bilateral tumour or cT ≥2c disease; intermediate‐risk: PSA dt 3–5 years, GS = 3 + 4 or cT2b disease; and low‐risk: PSA dt >5 years, without histopathological or clinical progression. Definitive treatment was recommended for patients in the high‐risk group and treatment options were discussed with those in the intermediate‐risk group.Results A total of 2291 PSA values obtained during AS were available, of which 2071 were considered valid in the 258 patients. PSA dt values with 95% CIs were calculated in 221 patients based on a median of 8 PSA values. The 95% CIs for PSA dt overlapped considerably and in up to 91% of the patients, the 95% CIs overlapped among the risk group definitions. A total of 26% (68/258 patients) underwent RP after meeting the progression criteria. There was no association between preoperative PSA dt and final histopathology ( P = 0.87).Conclusion The uncertainty of calculated PSA dt during AS leads to a significant risk of patients being misclassified in terms of risk of progression, which limits the use of PSA dt in the management of patients on AS .