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PSA recurrence: definitions, PSA kinetics, and identifying patients at risk
1Division of Urology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
The Canadian Journal of Urology
|May 5, 2006
Summary
Choosing optimal therapy after prostate-specific antigen (PSA) recurrence remains challenging. Short PSA doubling time (PSA-DT) predicts increased prostate cancer mortality and identifies patients who may benefit from salvage therapy.
Area of Science:
- Oncology
- Urology
- Biostatistics
Background:
- Optimal therapy selection for patients with prostate-specific antigen (PSA) recurrence is unclear.
- Lack of consensus on the PSA cutpoint for defining PSA failure post-radical prostatectomy (RP) or radiation therapy (XRT).
Purpose of the Study:
- To review the role of PSA kinetics, specifically PSA doubling time (PSA-DT), in risk stratification and treatment selection for recurrent prostate cancer.
Main Methods:
- Review of validated nomograms utilizing PSA kinetics for risk stratification.
- Analysis of the association between PSA doubling time and prostate cancer mortality.
- Evaluation of PSA-DT for identifying responders to salvage therapy.
Main Results:
- Validated nomograms stratify patients based on disease progression risk and cancer-specific death, largely driven by PSA kinetics.
- A short PSA doubling time (PSA-DT) significantly increases the risk of prostate cancer death within 5-10 years.
- PSA-DT can identify patients most likely to respond to local salvage therapy.
Conclusions:
- PSA kinetics, particularly PSA doubling time, are crucial for risk stratification and treatment decisions in recurrent prostate cancer.
- Short PSA-DT is a strong predictor of mortality and a key factor in selecting patients for salvage therapy.
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