Variation in serum prostate-specific antigen levels in men with prostate cancer managed with active surveillance Journal Article


Authors: Ehdaie, B.; Poon, B. Y.; Sjoberg, D. D.; Recabal, P.; Laudone, V.; Touijer, K.; Eastham, J.; Scardino, P. T.
Article Title: Variation in serum prostate-specific antigen levels in men with prostate cancer managed with active surveillance
Abstract: Objective: To describe fluctuations in prostate-specific antigen (PSA) levels in men managed with active surveillance (AS) to determine if a single PSA increase is a consistent measure to use to trigger intervention. Patients and Methods: We evaluated data on 541 patients undergoing AS between 1995 and 2011. PSA variation was described by studying the Kaplan–Meier probability of patients’ PSA levels reaching 4 or 7 ng/mL, falling below those thresholds, and then rising to those thresholds again. We also examined PSA variation by calculating the Kaplan–Meier probability of a PSA change followed by an equal or greater change in the opposite direction. Results: We analysed data on 541 patients undergoing AS with a median (interquartile range [IQR]) of 8 (6–12) PSA measurements and undergoing AS for a median (IQR) of 4 (2–6) years. The 5-year estimate of the probability of reaching a threshold PSA of 7 ng/mL was 40% (95% confidence interval [CI] 35–46%) and the 5-year estimate of subsequently falling below this threshold was 90% (95% CI 82–95%). The 5-year estimate of a PSA direction change was 95% (95% CI 93–97%) overall and 56% (95% CI 51–61%) for PSA direction changes of ≥1 ng/mL. Conclusions: We observed a high probability of variability in PSA levels for patients on AS. The probability of changes in PSA, defined by an increase to the specified thresholds or a rise >1 ng/mL within 6 months and subsequent decrease of equal or greater value on a subsequent measurement, increases over time; therefore, a single change in PSA level is not a reliable endpoint for patients on AS. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd
Keywords: prostate specific antigen; prostate cancer; active surveillance; psa
Journal Title: BJU International
Volume: 118
Issue: 4
ISSN: 1464-4096
Publisher: Wiley Blackwell  
Date Published: 2016-10-01
Start Page: 535
End Page: 540
Language: English
DOI: 10.1111/bju.13328
PUBMED: 26385021
PROVIDER: scopus
PMCID: PMC5523832
DOI/URL:
Notes: Article -- Export Date: 3 October 2016 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Vincent Laudone
    59 Laudone
  2. Peter T Scardino
    615 Scardino
  3. Abdelkrim Karim Touijer
    190 Touijer
  4. Daniel D. Sjoberg
    134 Sjoberg
  5. Behfar Ehdaie
    72 Ehdaie
  6. James Eastham
    422 Eastham
  7. Jessica Bing Ying Poon
    15 Poon