Prostate Cancer Progression In The Presence Of Undetectable Or Low Serum Prostate-Specific Antigen Level

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 16 Apr 2007 - 0:00 PDT

email to a friend   printer friendly   opinions  

UroToday.com- Patients treated with definitive therapy for prostate cancer (CaP) are reassured that a low or undetectable PSA means the absence of metastatic disease. However, exceptions to this can occur, as documented in a study from M.D. Anderson Cancer Center that appears in the online edition of Cancer.

Between 1999 and 2004, 4,145 patients diagnosed with prostate cancer were enrolled in the database at M.D. Anderson Cancer Center. A total of 100 patients were identified who had disease progression with a PSA level <2ng/ml. Disease progression was defined as metastasis in >1 of the following sites: bone, viscera or retroperitoneal lymph nodes above the aortic bifurcation. Forty-six men, representing 1.1% of all patients who were entered into the database had appropriate criteria for analysis.

Overall, 10 (22%) had undetectable serum PSA levels and 30 patients (65%) had PSA of <1ng/ml at the time of disease progression. Of the 25 men who had undergone radical prostatectomy, 7 were hormone naïve at the time of progression. The median increase in PSA was 0.25ng/ml at the time of progression. In 19 patients, there was no increase in PSA from the nadir level at the time of progression. The median PSA doubling time for the cohort was 7.6 months.

Atypical variants of CaP were identified in 21 of 46 patients; including 9 with ductal CaP, 8 with small cell variant, 2 with neuroendocrine tumors and 2 men with sarcomatoid tumors. Metastatic progression was most commonly in the bones, followed by liver, retroperitoneal lymph nodes and lungs. Progression was identified by bone scans, CT or MRI.

In patients with CaP variants, monitoring in addition to PSA may have value.

Dan Leibovici, Philippe E. Spiess, Piyush K. Agarwal, Shi-Ming Tu, Curtis A. Pettaway, Kate Hitzhusen, Randall E. Millikan, Louis L. Pisters

Cancer 2006;109(2): 198-204
Reviewed by UroToday.com Contributing Editor Christopher P. Evans, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2006 - UroToday

• Additional
• References
• Citations