Prostate Specific Antigen Kinetics in the Management of Prostate Cancer

Purpose

We review the usefulness of prostate specific antigen kinetics (ie prostate specific antigen velocity and doubling time) in the treatment of patients with prostate cancer.

Materials and Methods

The MEDLINE database was searched to identify studies investigating prostate specific antigen kinetics in patients with prostate cancer.

Results

Various techniques are available for estimating prostate specific antigen kinetics, but to minimize the impact of prostate specific antigen variability on such calculations at least a 90-day period and preferably more than 2 measurements should be used. There is little to suggest which measure of prostate specific antigen kinetics may be superior since both appear to provide useful prognostic information. Prostate specific antigen velocity is easier to calculate but prostate specific antigen doubling time may have greater biological justification. Retrospective studies show that before treatment prostate specific antigen kinetics provide prognostic information regarding the risk of treatment failure and subsequent death from cancer. Additionally, in patients treated surgically preoperative prostate specific antigen kinetics predict the risk of adverse pathology, while in those undergoing conservative treatment prostate specific antigen kinetics are associated with the risk of progression and need for intervention. In patients with biochemical failure after therapy prostate specific antigen kinetics predict the risk and potential site of clinical recurrence, the likely response to salvage therapy, and the risk of death from cancer. Preliminary assessments also suggest that prostate specific antigen kinetics may serve as a surrogate end point to replace cancer specific mortality.

Conclusions

Although prospective studies are lacking, the current literature suggests that prostate specific antigen kinetics provide valuable prognostic information, and should be further evaluated in clinical decision making and as a surrogate end point for future trials.

Key Words: prostatic neoplasms, prostate-specific antigen, prostatectomy, radiotherapy, survival

Abbreviations and Acronyms: ADT, androgen deprivation therapy, AS, active surveillance, bRFS, biochemical RFS, CSS, cancer specific survival, DRE, digital rectal examination, NS, not statistically significant, NR, not reported, OS, overall survival, PFS, progression-free survival, PSA, prostate specific antigen, PSADT, PSA doubling time, PSAV, PSA velocity, RFS, recurrence-free survival, sRFS, systemic RFS, WW, watchful waiting