title: Prediagnostic prostate-specific antigen kinetics and the risk of biopsy progression in active surveillance patients.
abstract: OBJECTIVE
  To analyze the association between prediagnostic prostate-specific antigen kinetics and the risk of biopsy progression in prostate cancer patients on active surveillance, and to study the effect of prediagnostic prostate-specific antigen values on the predictive performance of prostate-specific antigen velocity and prostate-specific antigen doubling time.
  
  
  METHODS
  The study included 137 active surveillance patients with two or more prediagnostic prostate-specific antigen levels measured over a period of at least 3 months. Two sets of analyses were carried out. First, the association between prostate-specific antigen kinetics calculated using only the prediagnostic prostate-specific antigen values and the risk of biopsy progression was studied. Second, using the same cohort of patients, the predictive value of prostate-specific antigen kinetics calculated using only post-diagnostic prostate-specific antigens and compared with that of prostate-specific antigen kinetics based on both pre- and post-diagnostic prostate-specific antigen levels was analyzed.
  
  
  RESULTS
  Of 137 patients included in the analysis, 37 (27%) had biopsy progression over a median follow-up period of 3.2 years. Prediagnostic prostate-specific antigen velocity of more than 2 ng/mL/year and 3 ng/mL/year was statistically significantly associated with the risk of future biopsy progression. However, after adjustment for baseline prostate-specific antigen density, these associations were no longer significant. None of the tested prostate-specific antigen kinetics based on combined pre- and post-diagnostic prostate-specific antigen values were statistically significantly associated with the risk of biopsy progression.
  
  
  CONCLUSIONS
  Historical prediagnostic prostate-specific antigens seems to be not clinically useful in patients diagnosed with low-risk prostate cancer on active surveillance.
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Viacheslav
authors.initials: V
authors.lastname: Iremashvili
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Shane L
authors.initials: SL
authors.lastname: Barney
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Kava
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Dipen J
authors.initials: DJ
authors.lastname: Parekh
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Sanoj
authors.initials: S
authors.lastname: Punnen
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000378:metabolism / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology*; D012306:Risk; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen
keywords: active surveillance; prostate biopsy; prostate cancer; prostate-specific antigen doubling time; prostate-specific antigen velocity