You have accessJournal of UrologyProstate Cancer: Markers I1 Apr 2014MP74-10 VARIATION OF SERUM PROSTATE-SPECIFIC ANTIGEN LEVELS FOR MEN WITH PROSTATE CANCER MANAGED WITH ACTIVE SURVEILLANCE Behfar Ehdaie, Bing Ying Poon, Daniel Sjoberg, Andrew Vickers, Itay Sternberg, Vincent Laudone, Karim Touijer, James Eastham, and Peter Scardino Behfar EhdaieBehfar Ehdaie More articles by this author , Bing Ying PoonBing Ying Poon More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Andrew VickersAndrew Vickers More articles by this author , Itay SternbergItay Sternberg More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , Karim TouijerKarim Touijer More articles by this author , James EasthamJames Eastham More articles by this author , and Peter ScardinoPeter Scardino More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2343AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Serum PSA is frequently used in active surveillance (AS) programs for prostate cancer (PC) to recommend reclassification biopsy. We sought to determine the degree of fluctuations in PSA levels in patients on AS to better inform decisions for a man whose isolated change in PSA may raise concerns about disease progression. METHODS We examined 676 men diagnosed with PC from 1995 to 2011 who were managed with AS. Men were excluded from our study if they had fewer than 4 PSA results available. PSA variation was described by studying the frequency patients’ PSA level reached a threshold and then went below that level. The a priori threshold for PSA was 7ng/mL as this is the midpoint between the biopsy threshold (4ng/mL) and an accepted criterion for intermediate risk disease (10ng/mL). We repeated this analysis for the biopsy threshold of 4ng/mL. We also examined PSA variation by calculating the frequency that change in PSA across consecutive measurements was followed by an inverse change of equal or greater magnitude. To determine clinically meaningful variation, we used an increase of 1ng/mL that was followed by a decrease of equal magnitude across measurements. The association between each measure of variation and number of PSA measurements was assessed using linear regression. RESULTS In 541 men studied, the cumulative incidence of discontinuing AS for definitive treatment within 5 years was 13%. Among 251(46%) patients who reached a PSA of 7ng/mL, 186(74%) decreased from this threshold at least once. 417 (77%) patients reached a PSA of 4ng/mL but their PSA measurements fluctuated around this threshold less often. In patients who reached a PSA of 4ng/mL or 7ng/mL, the number of PSA measurements was significantly associated with the frequency of variation across each threshold (p<0.001). Examining PSA direction, 471 (87%) patients experienced at least one change in PSA direction and the frequency of these changes was significantly associated with the number of PSA measurements (p<0.001). 238 (44%) patients experienced a clinically meaningful change in PSA direction and the frequency of these changes was significantly associated with the number of PSA measurements (p<0.001), suggesting that these changes would be observed with continued follow up. CONCLUSIONS Among men with PC managed with AS, considerable variability in PSA levels exists. The frequency of changes in PSA direction, including clinically meaningful changes, increases with more PSA measurements. Therefore, an isolated change in PSA level should not be used as an indication for reclassification biopsy. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e859-e860 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Behfar Ehdaie More articles by this author Bing Ying Poon More articles by this author Daniel Sjoberg More articles by this author Andrew Vickers More articles by this author Itay Sternberg More articles by this author Vincent Laudone More articles by this author Karim Touijer More articles by this author James Eastham More articles by this author Peter Scardino More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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