Rate of PSA Increase an Important Predictor for Outcomes in Prostate Cancer

Rate of PSA Increase an Important Predictor for Outcomes in Prostate Cancer

According to a recent article published in the Journal of Urology, the length of time it takes for levels of prostate-specific antigen levels to rise following a prostatectomy may be an important predictor of outcomes in patients with early prostate cancer.

The prostate is a gland of the male reproductive system. It produces some of the fluid that transports sperm during ejaculation. After skin cancer, prostate cancer is the most common form of cancer diagnosed in men.

Localized or early prostate cancer refers to cancer that has not spread from the prostate and surrounding tissues. One common treatment approach for early prostate cancer is the surgical removal of the prostate (a prostatectomy). However, a significant portion of patients who undergo a prostatectomy ultimately experience a cancer recurrence. Researchers are evaluating which possible patient variables or disease characteristics may be associated with an increased risk of recurrence; patients considered to be at a higher risk may wish to undergo more aggressive treatment than those at a lower risk.

Prostate-specific antigens (PSA) are proteins that are normally shed by the prostate into the bloodstream. Elevated PSA levels may indicate the presence of prostate cancer and response to therapy. Recent research has indicated that a rapid rise in PSA levels prior to diagnosis may be indicative of more aggressive or widespread cancer. Results have demonstrated that PSA doubling time (the time it takes for PSA levels to double) may be an important prognostic consideration in patients with prostate cancer; however, specific details on PSA rise are still being evaluated to help guide treatment decisions.

Researchers recently evaluated data from 2,290 men who underwent a prostatectomy between 1990 and 1999. Each patient had multiple PSA measurements prior to surgery. At a median follow-up of 7.1 years, researchers found that a rapid rise in PSA levels was associated with worse outcomes.

Men with a PSA doubling time of 18 months or less prior to surgery had over a 6-fold increased risk of death from prostate cancer compared with men whose PSA doubling time was greater than 18 months.
Men whose PSA rose more than 3.4 ng/ml per year also had over a 6-fold increased risk of death from prostate cancer compared with men whose PSA rose less than 3.4 ng/ml per year.
The researchers concluded that a PSA doubling time of 18 months or less and a rise of PSA levels of 3.4 ng/ml or greater per year prior to surgery is associated with a significantly higher death rate from prostate cancer following a prostatectomy in men with early prostate cancer. Although further study is necessary, and other patient factors need to be considered regarding individualized treatment options, it appears that these markers of PSA are associated with outcomes for this patient population. Patients with early prostate cancer may wish to discuss PSA doubling time and the rise of PSA with their physicians when deciding upon the most appropriate treatment.

Reference: Sengupta S, Myers R, Slezak J, et al. Preoperative Prostate Specific Antigen Doubling Time and Velocity are Strong and Independent Predictors of Outcomes Following Radical Prostatectomy. Journal of Urology. 2005;174:2191-2196.