title: Evaluation of prediagnostic prostate-specific antigen dynamics as predictors of death from prostate cancer in patients treated conservatively.
abstract: Prostate-specific antigen (PSA) dynamics have been proposed to predict outcome in men with prostate cancer. We assessed the value of PSA velocity (PSAV) and PSA doubling time (PSADT) for predicting prostate cancer-specific mortality (PCSM) in men with clinically localized prostate cancer undergoing conservative management or early hormonal therapy. From 1990 to 1996, 2,333 patients were identified, of whom 594 had two or more PSA values before diagnosis. We examined 12 definitions for PSADT and 10 for PSAV. Because each definition required PSA measurements at particular intervals, the number of patients eligible for each definition varied from 40 to 594 and number of events from 10 to 119. Four PSAV definitions, but no PSADT, were significantly associated with PCSM after adjustment for PSA in multivariable Cox proportional hazards regression. All four could be calculated only for a proportion of events, and the enhancements in predictive accuracy associated with PSAV had very wide confidence intervals. There was no clear benefit of PSAV in men with low PSA and Gleason grade 6 or less. Although evidence that certain PSAV definitions help to predict PCSM in the cohort exist, the value of incorporating PSAV in predictive models to assist in determining eligibility for conservative management is, at best, uncertain.
authors.affiliation: Department of Surgery Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: M Frank
authors.initials: MF
authors.lastname: O'Brien
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fearn
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Savage
authors.forename: Brandon
authors.initials: B
authors.lastname: Smith
authors.forename: Jason
authors.initials: J
authors.lastname: Stasi
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Fisher
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
authors.forename: R Timothy
authors.initials: RT
authors.lastname: Oliver
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Berney
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Foster
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vickers
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis
chemical_list: D017430:Prostate-Specific Antigen