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American Journal of Men's Health May 2011Significant number of prostate tumors are slow growing and could probably be left untreated. However, many are aggressive and can spread rapidly causing patient...
Significant number of prostate tumors are slow growing and could probably be left untreated. However, many are aggressive and can spread rapidly causing patient suffering and/or death. Current technology does not allow physicians to differentiate between slow growing and aggressive tumors at diagnosis. Hence, many patients are exposed to invasive treatment and its associated morbidities such as incontinence and impotence. Markers that enable differentiation between slow and fast progressing cancer will allow physicians to prevent unnecessary treatments on men who may not need them, and focus on the men with aggressive disease. A longitudinal study was conducted (N = 140) using mixed effects regression models to determine the association of obesity and smoking toward prostate cancer progression. These models account for correlation because of repeated measures over time, thus, using maximum amount of information provided by the subject. Estimates thus obtained are more robust and reliable than those obtained using data from a single time point. Rate of change of prostate-specific antigen (PSA) over time (PSA velocity) was used as a measure of prostate cancer progression. Results indicate that PSA velocity of overweight and obese subjects (0.59 and 1.05 ng/mL/year) was not significantly different as compared with normal weight subjects (p values .91 and .31, respectively). For men in the highest tertile of pack-years of smoking, PSA velocity was significantly higher as compared with never smokers 1.57 ng/mL/year (p = .04). Further studies with larger sample sizes and study designs specific to above exposures are needed before recommendations can be made to reduce weight or reduce/quit smoking.
Topics: Aged; Body Mass Index; Disease Progression; Humans; Male; Middle Aged; Obesity; Prostate-Specific Antigen; Prostatic Neoplasms; Smoking
PubMed: 21613377
DOI: 10.1177/1557988310390030 -
Central European Journal of Urology 2011This article is an attempt to present a contemporary view on the role of the kinetics of PSA levels as defined by PSA doubling time (PSADT) and PSA velocity (PSAV) in... (Review)
Review
What is the possible role of PSA doubling time (PSADT) and PSA velocity (PSAV) in the decision-making process to initiate salvage radiotherapy following radical prostatectomy in patients with prostate cancer?
This article is an attempt to present a contemporary view on the role of the kinetics of PSA levels as defined by PSA doubling time (PSADT) and PSA velocity (PSAV) in the decision-making process to initiate salvage radiotherapy in patients with prostate cancer after radical prostatectomy (RP). The dynamics of the rise of PSA levels may be an early endpoint parameter, preceding the diagnosis of distant metastasis or death due to prostate cancer based on a single PSA determination. Thus, it seems reasonable to include the kinetics of PSA levels, apart from single PSA determination, in the decision-making algorithm. In a group of patients after RP, PSADT might be an early endpoint that could replace cause-specific survival rate as a late endpoint. PSADT allows distinguishing subgroups of patients at high risk of distant metastases and death, which in turn may lead to a change in the further treatment strategy. Therefore, patients with short PSA doubling time should become a subgroup, in which hormonal therapy should be considered. To date, there is no unanimous consent to accept the criteria of assessment of the dynamics of PSA levels as determinants of treatment in case of recurrences following RP. However, a number of non-randomized clinical trials in patients after RP suggest it would be useful to include these parameters in the decision-making process. For instance, a relationship was found between increased PSA velocity (>2 ng/mL/year) before initiation of oncological treatment and increased (12-fold) risk of death. A number of well-documented retrospective analyses show that PSADT is one of the most important parameters to describe the disease aggressiveness. It has to be stressed that single determination of PSA levels is much less precise in terms of describing the biological aggressiveness of prostate cancer than PSADT. Of course, the question regarding the need to include the PSA levels kinetic parameters as crucial elements of patient management algorithms can be answered in a definitive manner only by randomized clinical trials.
PubMed: 24578866
DOI: 10.5173/ceju.2011.02.art3 -
Prostate International Mar 2020A common treatment for localized prostate cancer (PCa) is radiotherapy; however, effectiveness is hampered because of toxicities and tumor resistance. Cyclooxygenase-2...
Cyclooxygenase-2 inhibitors delay relapse and reduce Prostate Specific Antigen (PSA) velocity in patients treated with radiotherapy for nonmetastatic prostate cancer: a pilot study.
INTRODUCTION
A common treatment for localized prostate cancer (PCa) is radiotherapy; however, effectiveness is hampered because of toxicities and tumor resistance. Cyclooxygenase-2 (COX-2) inhibitors have been identified as potential agents that could improve treatment outcomes and have demonstrated ability to increase the radiosensitivity of many human carcinomas. This retrospective human study aims to investigate the ability of COX-2 inhibitors, celecoxib, and meloxicam, to improve treatment outcomes after radiotherapy.
METHODS
Prostate Specific Antigen (PSA) data of eligible patients were obtained from Genesis Cancer Care, Southport, Australia. The primary outcome was the percentage of patients in each group that had reached biochemical relapse at two and five years after treatment. Secondary outcomes included time to biochemical relapse and PSA velocity.
RESULTS
At two and five years after treatment, both the celecoxib (6.7%, 18.3%) and meloxicam (0.0%, 18.9%) showed lower relapse rates than the control (8.6%, 31.0%). Although not statistically significant, these results are clinically significant. In addition, the two treatment groups were found to increase the time to relapse, 46.20 months for celecoxib and 54.15 months for meloxicam, compared with the control group, 35.53 months. A similar trend was shown for PSA velocity with both treatment groups demonstrating lower PSA velocities compared with control.
CONCLUSIONS
This study provides further evidence to the potential for COX-2 inhibitors to address gaps in localizedz PCa treatment by demonstrating high clinical significance for the use of celecoxib and meloxicam. Further research should be conducted including larger retrospective studies and prospective studies to fully evaluate the benefits of COX-2 inhibitors in combination with radiotherapy for PCa.
PubMed: 32257976
DOI: 10.1016/j.prnil.2019.10.004 -
World Journal of Urology Feb 2011A PSA velocity (PSAV)>0.35 ng/ml/year approximately 10-15 years prior to diagnosis is associated with a greater risk of lethal prostate cancer. Some have recommended...
OBJECTIVES
A PSA velocity (PSAV)>0.35 ng/ml/year approximately 10-15 years prior to diagnosis is associated with a greater risk of lethal prostate cancer. Some have recommended that a PSAV>0.35 ng/ml/year should prompt a prostate biopsy in men with a low serum PSA (<4 ng/ml) and benign DRE. However, less is known about the utility of this PSAV cutpoint for the prediction of treatment outcomes among men undergoing radical prostatectomy (RP).
METHODS
Between 1992 and 2007, 339 men underwent RP at our institution with a preoperative PSA<4 ng/ml, benign DRE, and multiple preoperative PSA measurements. PSAV was calculated by linear regression analysis using all PSA values within 18 months prior to diagnosis. Kaplan-Meier survival analysis was performed, and biochemical progression rates were compared between PSAV strata using the log-rank test.
RESULTS
The preoperative PSAV was >0.35 ng/ml/year in 124 (36.6%) of 339 men. Although there were no significant differences in clinico-pathological characteristics based upon PSAV, men with a PSAV>0.35 ng/ml/year were significantly more likely to experience biochemical progression after RP at a median follow-up of 4 years (P=0.022).
CONCLUSIONS
In this low-risk population with a preoperative PSA<4 ng/ml and benign DRE, approximately 1/3 had a preoperative PSAV>0.35 ng/ml/year. Physicians should carefully monitor men with a preoperative PSA>0.35 ng/ml/year as they are at increased risk of biochemical progression following RP.
Topics: Digital Rectal Examination; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Predictive Value of Tests; Preoperative Period; Prognosis; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Regression Analysis; Retrospective Studies; Risk Factors
PubMed: 21153643
DOI: 10.1007/s00345-010-0625-4 -
The New England Journal of Medicine Jul 2004We evaluated whether men at risk for death from prostate cancer after radical prostatectomy can be identified using information available at diagnosis.
BACKGROUND
We evaluated whether men at risk for death from prostate cancer after radical prostatectomy can be identified using information available at diagnosis.
METHODS
We studied 1095 men with localized prostate cancer to assess whether the rate of rise in the prostate-specific antigen (PSA) level--the PSA velocity--during the year before diagnosis, the PSA level at diagnosis, the Gleason score, and the clinical tumor stage could predict the time to death from prostate cancer and death from any cause after radical prostatectomy.
RESULTS
As compared with an annual PSA velocity of 2.0 ng per milliliter or less, an annual PSA velocity of more than 2.0 ng per milliliter was associated with a significantly shorter time to death from prostate cancer (P<0.001) and death from any cause (P=0.01). An increasing PSA level at diagnosis (P=0.01), a Gleason score of 8, 9, or 10 (P=0.02), and a clinical tumor stage of T2 (P<0.001) also predicted the time to death from prostate cancer. For men with an annual PSA velocity of more than 2.0 ng per milliliter, estimates of the risk of death from prostate cancer and death from any cause seven years after radical prostatectomy were also influenced by the PSA level, tumor stage, and Gleason score at diagnosis.
CONCLUSIONS
Men whose PSA level increases by more than 2.0 ng per milliliter during the year before the diagnosis of prostate cancer may have a relatively high risk of death from prostate cancer despite undergoing radical prostatectomy.
Topics: Aged; Cause of Death; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Proportional Hazards Models; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Risk; Survival Analysis
PubMed: 15247353
DOI: 10.1056/NEJMoa032975 -
Scientific Reports Apr 2023To define a normal range for PSA values (ng/mL) by age and create a prediction model for prostate cancer incidence. We conducted a retrospective analysis using 263,073...
To define a normal range for PSA values (ng/mL) by age and create a prediction model for prostate cancer incidence. We conducted a retrospective analysis using 263,073 observations of PSA values in Japanese men aged 18-98 years (2007-2017), including healthy men and those diagnosed with prostate cancer. Percentiles for 262,639 PSA observations in healthy men aged 18-70 years were calculated and plotted to elucidate the normal fluctuation range for PSA values by age. Univariable and multivariable logistic regression analyses were performed to develop a predictive model for prostate cancer incidence. PSA levels and PSA velocity increased with age in healthy men. However, there was no difference in PSA velocity with age in men diagnosed with prostate cancer. Logistic regression analysis showed an increased risk of prostate cancer for PSA slopes ranging from 0.5 to 3.5 ng/mL/year. This study provides age-specific normal fluctuation ranges for PSA levels in men aged 18-75 years and presents a novel and personalized prediction model for prostate cancer incidence. We found that PSA slope values of > 3.5 ng/mL/year may indicate a rapid increase in PSA levels caused by pathological condition such as inflammation but are unlikely to indicate cancer risk.
Topics: Humans; Male; Big Data; East Asian People; Incidence; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies; Japan; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Reference Values; Risk Assessment; Risk Factors; Biomarkers, Tumor; Predictive Value of Tests
PubMed: 37085532
DOI: 10.1038/s41598-023-33725-8 -
BioMed Research International 2014PSA parameters have been used in an attempt to improve the diagnostic yield of prostate screening tests; the detection of primary malignant circulating prostate cells...
A comparative performance analysis of total PSA, percentage free PSA, PSA velocity, and PSA density versus the detection of primary circulating prostate cells in predicting initial prostate biopsy findings in Chilean men.
INTRODUCTION
PSA parameters have been used in an attempt to improve the diagnostic yield of prostate screening tests; the detection of primary malignant circulating prostate cells (CPCs) may improve the diagnostic yield of screening and therefore avoid unnecessary biopsies.
PATIENTS AND METHODS
Prospective study of all men undergoing initial prostate biopsy due to an elevated total serum PSA. Free percent PSA, PSA velocity, and PSA density were determined. Primary CPCs were detected using standard immunocytochemistry. A positive test for CPCs was defined as one cell PSA (+) P504S (+) in an 8 ml blood sample. Positive predictive and negative predictive values, specificity, and sensitivity were calculated for each test as well as the number of biopsies avoided and cancers missed.
RESULTS
303 men participated in the study of whom 113/303 (37.3%) men had prostate cancer. Of the three PSA based parameters, free percent PSA was superior, sensitivity 70.8%, and specificity 67.4%. Primary CPCs detection had a sensitivity of 88.5% and a specificity of 88.4% avoiding 181 (59.7%) biopsies, detecting 93/95 (98%) of clinically significant cancers, and missing 13 (11.5%) low grade, small volume tumors.
CONCLUSIONS
The use of primary CPCs as a sequential test could decrease the number of initial prostate biopsies missing those cancers which are treated by active observation.
Topics: Aged; Biopsy; Humans; Male; Middle Aged; Neoplastic Cells, Circulating; Predictive Value of Tests; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms
PubMed: 25101294
DOI: 10.1155/2014/676572 -
Urology Jan 2011To describe the distribution and implications of prostate-specific antigen velocity (PSAV) by prostate-specific antigen (PSA) in an unselected population. A PSAV >0.35...
OBJECTIVES
To describe the distribution and implications of prostate-specific antigen velocity (PSAV) by prostate-specific antigen (PSA) in an unselected population. A PSAV >0.35 and >2.0 ng/mL/y have been associated with an increased risk of prostate cancer (CaP) death more than 10 years and 1 year before diagnosis, respectively. It is unknown how frequently PSAVs of this magnitude occur in community men.
METHODS
From the Baltimore Longitudinal Study of Aging, we examined the PSAV distribution in 786 men with serial PSA measurements (3474 PSAV observations) at total PSA levels <10 ng/mL. We also determined whether PSAV altered the probability of overall and life-threatening CaP at PSA levels <3 and 3-10 ng/mL.
RESULTS
Overall, the mean PSA and PSAV were 1.3 ng/mL and 0.05 ng/mL/y, respectively. PSAV rose continuously with increasing PSA (P <.0001), and was significantly higher in cancers than controls for observations at PSA levels <3 ng/mL (P = .02) and 3-10 ng/mL (P = .0008). The probability of life-threatening CaP was 3% at a PSA <3 ng/mL, but increased to 13.6% with PSAV >0.4 ng/mL/y. At PSA levels of 3-10 ng/mL, the probability of life-threatening CaP was 9.8% based on PSA alone vs 12% with PSAV >0.4 ng/mL/y.
CONCLUSIONS
PSAV was significantly higher in CaP observations than controls in all PSA ranges studied and altered the risk of overall and life-threatening CaP at a given PSA level. Because the value of PSAV is PSA-dependent, the PSA level should be taken into account when interpreting PSAV.
Topics: Aged; Humans; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Prostate-Specific Antigen
PubMed: 21195835
DOI: 10.1016/j.urology.2010.04.068 -
European Urology Open Science Sep 2022The 2021 European Association of Urology recommendations for early prostate cancer detection included a risk-based algorithm. Risk assessment methods are proposed to...
UNLABELLED
The 2021 European Association of Urology recommendations for early prostate cancer detection included a risk-based algorithm. Risk assessment methods are proposed to prevent excessive use of prostate magnetic resonance imaging (MRI) and biopsy, simultaneously reducing overdiagnosis and overtreatment. However, the clinical implications of sequential use of risk assessment tests have not yet been properly assessed. We provide an appraisal of the recommended algorithm and evaluate its outcomes in a contemporary prospective study population of biopsy-naïve men. To increase the effectiveness in cases of limited MRI capacity, we show that use of the Rotterdam Prostate Cancer Risk Calculator-3 for pre-MRI risk stratification could avoid more than one-third of MRI examinations. After prostate MRI, use of either the Prostate Imaging-Reporting and Data System (PI-RADS) score or a risk model including MRI outcome as a variable could avoid six out of ten prostate biopsies while maintaining high sensitivity. However, implementation in health care systems requires due consideration of the access to and quality of diagnostic resources, as well as cost-effectiveness.
PATIENT SUMMARY
We evaluated the European Association of Urology risk-based strategy for early prostate cancer detection. Risk assessment before magnetic resonance imaging (MRI) using a risk calculator or prostate-specific antigen (PSA) density could reduce MRI demands and overdiagnosis of insignificant cancers. Risk assessment using prostate MRI results could avoid 60% of prostate biopsies while maintaining prostate cancer detection rates.The European Association of Urology (EAU) recently published its current position and recommendations on prostate-specific antigen (PSA) testing [1]. On the basis of the literature and expert opinion, a risk-based algorithm for early detection of prostate cancer (PCa) was proposed. The guideline recommends stratifying men with PSA ≥3 ng/ml as either "low risk", for whom magnetic resonance imaging (MRI) can be avoided, or "intermediate and high risk", for whom prostate MRI should be performed as a basis for further diagnostic decisions. Strategies must be developed to use health care resources efficiently and to reduce unnecessary morbidity, anxiety, and costs of diagnostics. However, any paradigm shift inevitably leads to a paucity of research data. As a result, there is still debate regarding which men can safely avoid an initial MRI but are subjected to clinical follow-up, and which men must undergo an immediate MRI. The authors proposed four methods for risk assessment: (1) family history; (2) PSA velocity; (3) PSA density; and (4) risk calculators. It must be stressed that the availability and quality of prostate MRI in each situation should be considered when using these pre-MRI risk assessment tools. We discuss in brief the proposed risk assessment methods including MRI and assess potential outcomes in a contemporary population.
PubMed: 35845549
DOI: 10.1016/j.euros.2022.06.006