A Commentary on PSA Velocity and Doubling Time for Clinical Decisions in Prostate Cancer - 27/02/14
Abstract |
Although the value of prostate-specific antigen (PSA) velocity or doubling time has never been seriously questioned for aiding the clinical management of recurrent or advanced cancer, there has historically been considerable uncertainty about PSA kinetics for decisions about biopsy and initial treatment. Recent studies, including analyses of cohorts from all the major randomized trials of localized prostate cancer, have failed to find any evidence that PSA velocity and application of PSA cutpoints are of benefit in this setting. Given current data on PSA velocity and doubling time, we propose the following “take home” messages for the practicing urologist: (1) High PSA velocity is not an indication for biopsy; (2) for men with a low total PSA but a high PSA velocity, consideration should be given to having PSA taken at a shorter interval; (3) men with an indication for biopsy should be biopsied irrespective of PSA velocity; (4) changes in PSA after negative biopsy findings do not determine the need for repeat biopsy; (5) monitoring PSA over time can aid judgment in decisions about biopsy, as informed by the clinical context; (6) PSA velocity is uninformative of risk at diagnosis; (7) high PSA velocity is not an indication for treatment in men on active surveillance; (8) PSA velocity at the time of recurrence should be entered into prediction models (or “nomograms”) to aid patient counseling; (9) PSA changes after treatment for advanced disease can help indicate therapeutic response.
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Financial Disclosure: A.J.V. is named as a coinventor on a patent application for a statistical method to predict the result of prostate biopsy for the organization Arctic Partners. The remaining authors declare that they have no relevant financial interests. |
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Funding Support: Supported in part by funds from David H. Koch provided through the Prostate Cancer Foundation, the Sidney Kimmel Center for Prostate and Urologic Cancers, P50-CA92629 SPORE grant from the National Cancer Institute to Dr. H. Scher, and the P30-CA008748 Cancer Center Support Grant. |
Vol 83 - N° 3
P. 592-598 - mars 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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