UroToday - Prostate-Specific Antigen Kinetics in Clinical Decision-Making During Active Surveillance for Early Prostate Cancer-A Review - Abstract

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Monday, 07 July 2008

Department

of Urology, Erasmus MC, University Medical Center,

Rotterdam, the Netherlands.

The

kinetics of prostate specific antigen (PSA) are generally assumed to be

indicative of tumour progression and are therefore used in clinical

decision-making in men on active surveillance for early prostate cancer.

This

review aims to provide support for exploiting PSA kinetics in an active

surveillance setting.

We

searched the Medline database and reviewed the evidence on both the relation

between PSA kinetics before radical treatment for prostate cancer and outcome,

as well as the role of PSA kinetics during active surveillance. Furthermore,

the benefits and setbacks of different derivatives of PSA kinetics, minimum

required time interval and number of measurements, practical recommendations,

and pitfalls of their use in clinical practice are discussed.

The

evidence concerning the prognostic value of the PSA velocity (PSA-V) and PSA

doubling time (PSA-DT) is sparse, especially in active surveillance. PSA

kinetics should therefore be combined with other diagnostic measures as the

trigger for deferred radical treatment or repeat prostate biopsies. There seems

to be consensus among several reports on the unfavourable outcome relating to a

PSA-DT <3-4 yr and on the favourable prognostic value of a PSA-DT >10 yr

or a decreasing PSA level. Online tools provide help with calculations and

insight on disease development. The best method of calculation, number of

measurements, and time interval between measurements is unknown for now.

Despite

the current deficits in our understanding of the natural behaviour of early

prostate cancer and its relation to serum PSA levels, and despite several

secondary factors playing a role in PSA kinetics, PSA kinetics are a practical

parameter we can offer men on active surveillance to assess the status of their

disease.

Written

by

van den Bergh RC, Roemeling S, Roobol MJ, Wolters T, Schröder FH, Bangma CH.

Reference

Eur Urol. 2008 Jun 20. Epub ahead of print.

doi:10.1016/j.eururo.2008.06.040

PubMed

Abstract

PMID:18585845