Prostate-Specific Antigen Velocity Linked to Mortality
Increasing levels at recurrence associated with death only in patients with minimal comorbidities
THURSDAY, Oct. 29 (HealthDay News) -- Men with unfavorable prostate cancer whose prostate-specific antigen (PSA) levels rapidly increase at recurrence have a higher risk of death, but only if they have no or minimal comorbidities, according to a study published online Oct. 26 in the Journal of Clinical Oncology.
Jennifer Y. Wo, M.D., from Harvard Medical School in Boston, and colleagues analyzed data on PSA velocity at recurrence and mortality from a clinical trial that had randomly assigned 206 men with localized prostate cancer with at least one unfavorable prognostic factor to radiation therapy alone or combined with androgen suppression therapy.
During a median follow-up of 8.4 years, the researchers observed 89 biochemical recurrences and 74 deaths from any cause. Among all patients, and after adjusting for a number of factors, higher PSA velocity was significantly associated with a higher risk of all-cause mortality (hazard ratio, 1.47). Among patients with biochemical recurrence, higher PSA velocity at recurrence was also significantly associated with a higher risk of mortality (hazard ratio, 1.60), but only for patients with no or minimal comorbidities. Moderate to severe comorbidity was significantly associated with mortality (hazard ratio, 7.94) among patients with biochemical recurrence.
"Rapid PSA velocity at recurrence is significantly associated with an increased risk of all-cause mortality among patients with no or minimal comorbidity but not moderate to severe comorbidity," Wo and colleagues conclude. "These findings support judicious use of salvage androgen suppression therapy, particularly in men with moderate to severe comorbidities, where prospective surveillance protocols are needed."