Prostate-specific antigen kinetics after failure of primary prostate cancer therapy: a valuable prognostic factor

Evaluation of: Freedland SJ, Humphreys EB, Mangold LA et al.: Death in patients with recurrent prostate cancer after radical prostatectomy: prostate-specific antigen doubling time subgroups and their associated contributions to all-cause mortality. J. Clin. Oncol. 25(13), 1765-1771 (2007). In this article by Freedland and colleagues, prostate-specific antigen doubling time (PSAdt) is shown as a strong prognostic factor for subsequent death. Those with fast doubling times (< 3-6 months) have a relatively short disease course, with a median survival of 6.5 years, whereas those with slow doubling times (>/=15 months) have relatively indolent disease with prostate cancer-specific mortality rates of under 5% after 10 years. Prostate cancer is the most common cause of death for those with a PSAdt of less than 15 months. These patients may be selected for consideration of early secondary intervention and experimental management, although there is no clear evidence that earlier, as opposed to later, intervention leads to an overall survival gain, and quality of life may be adversely affected by intervention. The intelligent use of PSAdt allows the selection of those in whom early intervention may be avoided.