Copyright © 2008 Elsevier Inc. All rights reserved.
Clinical Investigation
Postoperative Prostate-Specific Antigen Velocity Independently Predicts for Failure of Salvage Radiotherapy After Prostatectomy
At a median followup of 7.1 years (range 0.1 to 14.5) biochemical progression, clinical progression and death from prostate cancer were observed in 583, 156 and 42 patients, respectively. The HR for death from prostate cancer was 6.22 (95%CI 3.33 to 11.61) in men with PSADT less than 18 months vs 18 or greater and 6.54 (95%CI 3.51 to 12.19) in men with PSAV greater than 3.4 ng/ml yearly vs 3.4 or less. On multivariate analysis adjusting for preoperative or postoperative variables PSADT and PSAV remained significant predictors of each outcome. When assessed jointly, PSAV was significant as a predictor of biochemical progression, while PSADT was a significant predictor of clinical progression and cancer death.
This study confirms the usefulness of preoperative PSA kinetics for predicting post-RRP outcomes, which may be useful for stratifying patients, so that rational management decisions can be made with respect to observation, intervention and adjuvant treatment. While PSADT maybe biologically more accurate and stronger on multivariate analysis, PSAV is clinically easier to use and a good approximation in the short term.
f4c1e9834" onMouseOver="InfoBubble.show('infobubble_2','mlktLink_2')" onMouseOut="InfoBubble.timeout()">Early Detection of Prostate Cancer in 2007: Part 1: PSA... European Urology |
Early Detection of Prostate Cancer in 2007: Part 1: PSA and PSA Kinetics European Urology, Volume 53, Issue 3, March 2008, Pages 468-477 Fritz H. Schrxf6;der, H. Ballentine Carter, Tineke Wolters, Roderick C.N. van den Bergh, Claartje Gosselaar, Chris H. Bangma, Monique J. Roobol Abstract ObjectiveThis is the first of two review papers attempting to clarify the best way to detect prostate cancer (PCa) in 2007. Screening for PCa has not yet been shown to lower PCa mortality. Still, opportunistic screening is wide spread in Europe and in most other parts of the world.MethodsCurrent literature and data from screening studies are reviewed and discussed. Prostate-specific antigen (PSA) has been and remains one of the corner stones of early detection of PCa. Traditionally used cut-off values cannot be applied in an uncritical fashion after it was shown that a significant amount of overdiagnosis and that large proportions of cancers and poorly differentiated cancers are present in the low PSA ranges. The paper addresses the continued relevance of PSA cut-off values. The diagnostic value of PSA velocity is reviewed in conjunction with PSA cut-off values and as a possible replacement of total PSA. A need for more selective screening in the low PSA ranges is pointed out. Results and conclusionsThe data show that men presenting initially with PSA values below 1 do not have to be rescreened for a period of 8 yr. In the PSA range 1–2.9 ng/ml, new parameters are needed that improve specificity and are selective for screening for aggressive lesions. PSA velocity so far has not been shown to be useful in the early detection of PCa but may be useful in detecting aggressive PCa selectively. For the time being, it seems sensible to continue using PSA cut-off values such as 3.0 or 4.0 ng/ml provided overtreatment is decreased by using available nomograms. Purchase PDF (282 K) |
Biochemical Recurrence after Localized Treatment Urologic Clinics of North America |
Biochemical Recurrence after Localized Treatment Urologic Clinics of North America, Volume 33, Issue 2, May 2006, Pages 147-159 Christopher L. Amling |
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Postoperative Prostate-Specific Antigen Velocity Independently Predicts for Failure of Salvage Radiotherapy After Prostatectomy