Variation in serum prostate‐specific antigen levels in men with prostate cancer managed with active surveillance. (26th October 2015)

• Record Type: Journal Article
• Authors: Ehdaie, Behfar; Poon, Bing Ying; Sjoberg, Daniel D.; Recabal, Pedro; Laudone, Vincent; Touijer, Karim; Eastham, James; Scardino, Peter T.
• Is Part Of: BJU international. Volume 118:Number 4(2016:Aug.)
• Page Start: 535
• Page End: 540
• Publication Date: 2015-10-26
• Subjects: prostate cancer -- active surveillance -- prostate specific antigen -- PSA; Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.13328
• Languages: English
• ISSNs: 1464-4096

Abstract

Abstract : Objective: To describe fluctuations in prostate‐specific antigen (PSA) levels in men managed with active surveillance (AS) to determine if a single PSA increase is a consistent measure to use to trigger intervention. Patients and Methods: We evaluated data on 541 patients undergoing AS between 1995 and 2011. PSA variation was described by studying the Kaplan–Meier probability of patients' PSA levels reaching 4 or 7 ng/mL, falling below those thresholds, and then rising to those thresholds again. We also examined PSA variation by calculating the Kaplan–Meier probability of a PSA change followed by an equal or greater change in the opposite direction. Results: We analysed data on 541 patients undergoing AS with a median (interquartile range [IQR]) of 8 (6–12) PSA measurements and undergoing AS for a median (IQR) of 4 (2–6) years. The 5‐year estimate of the probability of reaching a threshold PSA of 7 ng/mL was 40% (95% confidence interval [CI] 35–46%) and the 5‐year estimate of subsequently falling below this threshold was 90% (95% CI 82–95%). The 5‐year estimate of a PSA direction change was 95% (95% CI 93–97%) overall and 56% (95% CI 51–61%) for PSA direction changes of ≥1 ng/mL. Conclusions: We observed a high probability of variability in PSA levels for patients on AS. The probability of changes in PSA, defined by an increase to the specified thresholds or a rise >1 ng/mL within 6 months and subsequent decrease of equal or greater value on a subsequent measurement, increases over time; therefore, a single change in PSA level is not a reliable endpoint for patients on AS.