Variation of Serum Prostate-Specific Antigen in Men with Prostate Cancer Managed with Active Surveillance.

To describe fluctuations in PSA levels in men managed with AS to determine if a single PSA increase is a consistent measure to trigger intervention.

We evaluated data on 541 men on AS from 1995 through 2011.

PSA variation was described by studying the Kaplan-Meier probability of patients' PSA levels reaching 4 or 7 ng/mL, going 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.

We analyzed data on 541 AS patients with a median of 8 PSA measurements (IQR, 6-12) on AS for a median of 4 years (IQR, 2-6). The 5-year estimate of the probability of reaching a threshold PSA of 7 ng/mL was 40% (95% 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.

We observed a high probability of variability in PSA levels for men on AS. The probability of changes in PSA, defined by an increase to specified thresholds or a rise >1ng/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 men on AS. This article is protected by copyright. All rights reserved.

BJU international. 2015 Sep 19 [Epub ahead of print]

Behfar Ehdaie, Bing Ying Poon, Daniel D Sjoberg, Pedro Recabal, Vincent Laudone, Karim Touijer, James Eastham, Peter T Scardino

Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. , Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

PubMed