Is It Time to Revisit the Role of Prostate-Specific Antigen Kinetics in Active Surveillance for Prostate Cancer?

OBJECTIVES - To identify factors which are not available at the time of prostate cancer diagnosis and are associated with the risk of biopsy progression in active surveillance patients.

METHODS - The study included 314 active surveillance patients who had at least one repeat biopsy.

We used logistic regression to analyze the association between prostate-specific antigen (PSA) and its derivatives including PSA density (PSAD), PSA velocity (PSAV) and doubling time (PSADT), presence of bilateral disease and number of previous successive negative surveillance biopsies and the risk of progression on the surveillance biopsies 1st through 4th.

RESULTS - Over a median follow-up of 3.1 years patients had a mean of 2.4 biopsies. The median time from diagnosis to the last biopsy was 2.3 years. The biopsies were performed at fairly equal intervals. For surveillance biopsies 1 through 3 none of the studied factors was adding significant prognostic information to the baseline characteristics. PSAV and PSADT were associated with the risk of progression on the 4th biopsy; this association was independent of baseline characteristics. No progression on the 4th biopsy was noted in 23 patients with negative PSAV. Among 54 patients with PSADT of more than 3 years only two progressed while 6 out of 9 patients with a PSADT less than 3 years had biopsy progression on the 4th surveillance biopsy.

CONCLUSIONS - PSA kinetics may be helpful in defining the indications for prostate biopsy in active surveillance patients who are followed with regular biopsies for more than 3-4 years. .

Urology. 2016 Apr 26 [Epub ahead of print]

V Iremashvili, B R Kava, M Manoharan, D J Parekh, S Punnen

Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA. Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA., Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA., Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA., Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.