Prostate-specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer

Authors

  • Frederik Birkebæk Thomsen,

    Corresponding author
    1. Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
    • Correspondence: Frederik Birkebæk Thomsen, Tagensvej 20, afsnit 7521, 2200 Copenhagen, Denmark.

      e-mail: thomsen.frederik@gmail.com

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  • Ib Jarle Christensen,

    1. The Finsen Laboratory, Copenhagen Biocenter and Biotech Research and Innovation Centre, Copenhagen, Denmark
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  • Klaus Brasso,

    1. Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Martin Andreas Røder,

    1. Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Peter Iversen

    1. Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract

Objectives

  • To elucidate the role of prostate-specific antigen (PSA) doubling time (PSAdt) as a progression criterion in patients with low-risk prostate cancer managed by active surveillance (AS).
  • To assess the correlation between PSAdt during AS and final histopathology after radical prostatectomy (RP) in patients meeting predefined progression criteria.

Patients and Methods

  • A total of 258 consecutive patients on an AS programme were included in the study.
  • The PSAdt was calculated in patients with two or more PSA values, and 95% confidence intervals (CIs) were calculated in patients with four or more PSA values.
  • Progression risk groups were defined as follows: high-risk: PSAdt <3 years, rebiopsy Gleason score (GS) ≥4 + 3, more than three positive biopsy cores, and/or bilateral tumour or cT ≥2c disease; intermediate-risk: PSAdt 3–5 years, GS = 3 + 4 or cT2b disease; and low-risk: PSAdt >5 years, without histopathological or clinical progression.
  • Definitive treatment was recommended for patients in the high-risk group and treatment options were discussed with those in the intermediate-risk group.

Results

  • A total of 2291 PSA values obtained during AS were available, of which 2071 were considered valid in the 258 patients.
  • PSAdt values with 95% CIs were calculated in 221 patients based on a median of 8 PSA values.
  • The 95% CIs for PSAdt overlapped considerably and in up to 91% of the patients, the 95% CIs overlapped among the risk group definitions.
  • A total of 26% (68/258 patients) underwent RP after meeting the progression criteria.
  • There was no association between preoperative PSAdt and final histopathology (P = 0.87).

Conclusion

  • The uncertainty of calculated PSAdt during AS leads to a significant risk of patients being misclassified in terms of risk of progression, which limits the use of PSAdt in the management of patients on AS.

Ancillary