PURPOSE: Prostate-specific antigen velocity (PSAV) has been found to be an unreliable predictor of adverse pathology for patients on active surveillance for low-risk prostate cancer.
However, a new concept called PSAV risk count (RC), recently validated in a screening cohort, has not been investigated in an active surveillance cohort.
MATERIALS AND METHODS: We evaluated a cohort of men (1995-2012) with prostate cancer on active surveillance (stage T1c disease, PSA density< 0.15 ng/mL, Gleason score≤ 6, ≤ 2 biopsy cores and ≤ 50% involvement of any core with cancer). Men were observed by semiannual PSA measurements, digital rectal examinations, and an annual surveillance biopsy. Treatment was recommended for biopsy reclassification. Patients with ≥30 months follow-up and three serial PSAVs constituted the primary analysis using logistic regression, Cox proportional hazards, Kaplan-Meier analysis, and performance parameters including area under the receiver operating characteristic curve (AUC).
RESULTS: Primary analysis included 275 of 668 men meeting very-low-risk inclusion criteria with 83(30.2%) reclassified at 57.1 months (median). Reclassification risk increased with RC with associations for a RC of three [HR4.63 (95%CI 1.54-13.87)] and two [HR3.73 (95%CI 1.75-7.97)] compared to zero, and similarly for Gleason score reclassification (RC of three [HR7.45 (95%CI 1.60-34.71)] and two [HR3.96 (95%CI 1.35-11.62)]). Negative predictive value (RC≤ 1) was 91.5% for reclassification in the next year on secondary analysis. Addition of PSAV RC improved AUC for a model including baseline PSA density (0.7423vs.0.6818,p=0.025) and outperformed addition of overall PSAV (0.7423vs.0.6960,p=0.037).
CONCLUSION: PSAV RC may be useful to monitor patients on active surveillance and reduce the frequency of biopsies needed in the long-term.
Written by:
Patel HD, Feng Z, Landis P, Trock BJ, Epstein JI, Carter HB. Are you the author?
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Reference: J Urol. 2013 Sep 20. pii: S0022-5347(13)05468-2.
doi: 10.1016/j.juro.2013.09.029
PubMed Abstract
PMID: 24060641
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