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

Frederik Birkebaek Thomsen; Ib Jarle Christensen; Klaus Brasso; Martin Andreas Røder; Peter Iversen

doi:10.1111/bju.12367

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

Frederik Birkebaek Thomsen, Ib Jarle Christensen, Klaus Brasso, Martin Andreas Røder, Peter Iversen

13 Citations (Scopus)

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.

Original language	English
Journal	B J U International (Print)
Volume	113
Issue number	5b
Pages (from-to)	E98-105
ISSN	1464-4096
DOIs	https://doi.org/10.1111/bju.12367
Publication status	Published - 2014

Keywords

Aged
Disease Progression
Humans
Male
Middle Aged
Prospective Studies
Prostate-Specific Antigen
Prostatic Neoplasms
Risk Assessment
Time Factors
Watchful Waiting

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/bju.12367

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Prostate-specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer. / Thomsen, Frederik Birkebaek; Christensen, Ib Jarle; Brasso, Klaus et al.

In: B J U International (Print), Vol. 113, No. 5b, 2014, p. E98-105.

Research output: Contribution to journal › Journal article › Research › peer-review

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

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.",

keywords = "Aged, Disease Progression, Humans, Male, Middle Aged, Prospective Studies, Prostate-Specific Antigen, Prostatic Neoplasms, Risk Assessment, Time Factors, Watchful Waiting",

author = "Thomsen, {Frederik Birkebaek} and Christensen, {Ib Jarle} and Klaus Brasso and R{\o}der, {Martin Andreas} and Peter Iversen",

note = "{\textcopyright} 2013 The Authors. BJU International {\textcopyright} 2013 BJU International.",

year = "2014",

doi = "10.1111/bju.12367",

language = "English",

volume = "113",

pages = "E98--105",

journal = "BJU International",

issn = "1464-4096",

publisher = "Wiley-Blackwell",

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TY - JOUR

T1 - Prostate-specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer

AU - Thomsen, Frederik Birkebaek

AU - Christensen, Ib Jarle

AU - Brasso, Klaus

AU - Røder, Martin Andreas

AU - Iversen, Peter

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Aged

KW - Disease Progression

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Prostate-Specific Antigen

KW - Prostatic Neoplasms

KW - Risk Assessment

KW - Time Factors

KW - Watchful Waiting

U2 - 10.1111/bju.12367

DO - 10.1111/bju.12367

M3 - Journal article

C2 - 24053601

SN - 1464-4096

VL - 113

SP - E98-105

JO - BJU International

JF - BJU International

IS - 5b

ER -

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

Abstract

Keywords

UN SDGs

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