2138 PROSTATE-SPECIFIC ANTIGEN RISES FASTER IN PATIENTS WITH MULTIPLE NEGATIVE BIOPSIES COMPARED TO PATIENTS FOLLOWED BY ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 20102138 PROSTATE-SPECIFIC ANTIGEN RISES FASTER IN PATIENTS WITH MULTIPLE NEGATIVE BIOPSIES COMPARED TO PATIENTS FOLLOWED BY ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER Akshat C. Pujara, Andrew J. Stephenson, Ranko Miocinovic, Ryan K. Berglund, and J. Stephen Jones Akshat C. PujaraAkshat C. Pujara More articles by this author , Andrew J. StephensonAndrew J. Stephenson More articles by this author , Ranko MiocinovicRanko Miocinovic More articles by this author , Ryan K. BerglundRyan K. Berglund More articles by this author , and J. Stephen JonesJ. Stephen Jones More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate-specific antigen (PSA) is historically used as a marker of disease progression in most prostate cancer (PCa) active surveillance (AS) protocols without evidence of its utility. We compared PSA dynamics in AS patients to patients with similar clinical findings who had at least two prior negative biopsies and are unlikely to have prostate cancer. METHODS Data were collected from a prospective database and chart review. AS patients were defined as those having favorable clinical features and biopsy parameters at diagnosis and repeat biopsy confirming low-risk disease. The control group consisted of patients considered to have no known disease by virtue of at least two prior negative biopsies. Patients were matched by age (5 year increments), PSA (1 ng/ml increments), BMI (increments of 5), gland volume (20 cm3 increments) at diagnostic or first negative biopsy, respectively, and race. PSA values were adjusted for 5-alpha reductase inhibitor use. RESULTS From February 2000 to August 2009, 99 men were followed by AS for low-risk PCa. Of these, 46 could be matched to 53 of 434 men in the control group. At diagnostic biopsy (AS) and first negative biopsy (control), mean age was 68 ± 7 and 64 ± 6 years, mean PSA 5.84 ± 3.71 and 5.19 ± 1.67 ng/ml, mean BMI 28 ± 4 and 28 ± 4, and mean gland volume 47 ± 24 and 45 ± 13 cm3, respectively. Median interval from diagnosis to last PSA was 1.3 years (IQR 0.9 - 1.7) in AS patients and from first negative biopsy to last PSA 1.6 years (IQR 1.1 - 2.3) in the control group. Median PSA doubling time was 4.6 years (IQR 2.4 - 10.3) in AS patients and 4.31 years (IQR 2.8 - 7.0) in the control group. Median PSA velocity was 0.62 ng/ml/year (IQR 0.60 - 0.68) in AS patients and 1.63 ng/ml/year (IQR 0.79 - 2.59) in the control group (Figure 1). CONCLUSIONS PSA dynamics in patients with multiple negative PSA-triggered biopsies reflect a more rapidly rising PSA than in AS patients over short term-intervals. This finding calls into question the value of using PSA changes to follow patients on AS. Routine surveillance biopsy or magnetic resonance imaging may be warranted in AS patients regardless of PSA. Longer follow-up is required to further evaluate PSA dynamics in AS patients and implications for disease management. Cleveland, OH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e831 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshat C. Pujara More articles by this author Andrew J. Stephenson More articles by this author Ranko Miocinovic More articles by this author Ryan K. Berglund More articles by this author J. Stephen Jones More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...