Prostate specific antigen velocity as a measure of the natural history of prostate cancer: defining a ‘rapid riser’ subset

• Published in: British Journal of Urology Vol. 81; no. 1; pp. 100 - 104
• Main Authors: NAM, R. K, KLOTZ, L. H, JEWETT, M. A. S, DANJOUX, C, TRACHTENBERG, J
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.01.1998; Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Humans; Male; Medical sciences; Middle Aged; natural history; Nephrology. Urinary tract diseases; prostate cancer; Prostate specific antigen; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - surgery; PSA velocity; Tumors of the urinary system; Urinary tract. Prostate gland; Human; Urinary system disease; Prostate disease; Linear regression; Stage classification; Male; Malignancy; Tumoral marker; Malignant tumor; Prostate specific antigen; Male genital diseases; Time analysis; Prostate; Quantitative analysis
• ISSN: 0007-1331; 1464-410X
• DOI: 10.1046/j.1464-410x.1998.00523.x

Objective  To study the rate of change in prostate specific antigen (PSA velocity) in patients with prostate cancer initially managed by ‘watchful waiting’. Patients and methods  Serial PSA levels were determined in 141 patients with prostate cancer confirmed by biopsy, who were initially managed expectantly and enrolled between May 1990 and December 1995. Sixty‐seven patients eventually underwent surgery (mean age 59 years) because they chose it (the decision for surgery was not based on PSA velocity). A cohort of 74 patients remained on ‘watchful waiting’ (mean age 69 years). Linear regression and logarithmic transformations were used to segregate those patients who showed a rapid rise, defined as a>50% rise in PSA per year (or a doubling time of <2 years) and designated ‘rapid risers’. Results  An initial analysis based on a minimum of two PSA values showed that 31% were rapid risers. Only 15% of patients with more than three serial PSA determinations over ≥6 months showed a rapid rise in PSA level. There was no advantage of log‐linear analysis over linear regression models. Conclusion  Three serial PSA determinations over ≥6 months in patients with clinically localized prostate cancer identifies a subset (15%) of patients with a rapidly rising PSA level. Shorter PSA surveillance with fewer PSA values may falsely identify patients with rapid rises in PSA level. However, further follow‐up is required to determine if a rapid rise in PSA level identifies a subset of patients with an aggressive biological phenotype who are either still curable or who have already progressed to incurability through metastatic disease.