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PSA Kinetics Not Reliable in Predicting Adverse Pathology

Researchers say PSA kinetics should not replace surveillance biopsy in men on active surveillance

WEDNESDAY, May 5 (HealthDay News) -- Prostate-specific antigen (PSA) velocity (PSAV) and doubling time (PSADT) do not appear to be reliable in predicting adverse pathology, and should not replace annual surveillance biopsy in men undergoing active surveillance for prostate cancer, according to a study published online May 3 in the Journal of Clinical Oncology.

To assess the predictive ability of PSAV and PSADT for biopsy progression and adverse pathology at prostatectomy, Ashley E. Ross, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues evaluated 290 men who met criteria for active surveillance with at least two serial PSA measurements after being diagnosed between 1994 and 2008.

After a median follow-up of 2.9 years, 65 percent of men remained on active surveillance, and 35 percent had developed biopsy progression. The researchers found that PSADT had no significant association with adverse biopsy findings, and that PSAV was only marginally significant. In terms of biopsy progression, neither PSAV nor PSADT had a cut point with both high sensitivity and specificity. In addition, PSAV and PSADT were not linked to the presence of unfavorable surgical pathology in men who eventually underwent radical prostatectomy.

"In light of these findings, we caution against relying on PSA kinetics in low-risk men on active surveillance, and we recommend careful follow-up with annual surveillance biopsy to trigger intervention within the window of curability," the authors conclude.

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