New Role for PSA After Prostate Surgery

The velocity and doubling time of prostate specific antigen (PSA) can be used to predict the progression of disease and likelihood of death following surgery for prostate cancer, according to a new study published in the December 2005 issue of The Journal of Urology.

Previously, levels of PSA were used to predict disease progression and mortality following radical prostatectomy but have been found unsatisfactory in that role. In the new study, scientists reviewed the records of 2, 290 patients with multiple preoperative PSA measurements and 5, 176 patients with one measurement, the rate at which PSA increased in the body. The scientists looked at both the PSA velocity (PSAV), or increase over time, and also the doubling time (PSADT) of PSA, which indicates how quickly PSA levels double. While PSAV is simpler to calculate, they found that PSADT was a better indicator of untreated prostate cancer.

Over a follow-up period of about seven years, cancer spread or recurrence and deaths from the disease were recorded. Progression was found in 25.5% of patients, progression in 6.8%, and cancer death in 1.8%. Both PSAV and PSADT predicted progression and death. A PSAV greater than 3.4 ng/ml correlated to men who were 6.54 times more likely to die, while a PSADT quicker than 18 months correlated to a risk of death that was 6.22 times higher.

"This provides valuable pretreatment prognostic factors for prostate cancer,” noted primary author Shomik Sengupta, M.D., Mayo Clinic (Rochester, NY, USA). "We hope our work will help in the doctor-patient discussion and result in more-informed decisions relating to observation, intervention, and adjuvant treatment.”




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