Beyond The Abstract - Prostate Specific Antigen Kinetics In The Management Of Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 23 Mar 2008 - 0:00 PDT

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UroToday.com - Prostate-specific antigen (PSA) testing has significantly impacted on the diagnosis and management of prostate cancer since its advent in the 1980s. Recently, it has become evident that in addition to the PSA value at one particular moment, the changes in PSA over time (PSA kinetics) may be a useful measurement for patients with prostate cancer

This review examines the published data on PSA kinetics, in order to establish its current status in the management of prostate cancer. With data emerging at various stages of prostate cancer treatment by all mainstream modalities (i.e. active surveillance, external beam radiation, brachytherapy and surgery), PSA kinetics appear to significant prognostic importance. Some studies have even suggested using measures of PSA kinetics as a surrogate marker for prostate cancer mortality. Furthermore, PSA kinetics may be useful in a diagnostic setting, such as to direct the timing or need for initial or repeat biopsies.

A few limitations in the available data need to be noted. The majority of studies are retrospective single institution series, although at least two large prospective series have also been reported (the Prostate cancer prevention trial and Dr. Catalona's screening study). The availability of multiple measures of PSA kinetics (e.g. PSA velocity, PSA doubling time and time to recurrence) can cause confusion. PSADT has an empiric biologic basis in exponential modeling of cancer growth, but in most settings PSA velocity provides an adequate approximation and is easier to estimate.

The authors feel that PSA kinetics need to be an integral part of management of patients with prostate cancer, and this review provides a summary of the current data.

Written by Michael L. Blute, MD, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

Link to full abstract

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