Development of a New Method for Monitoring Prostate-Specific Antigen Changes in Men with Localised Prostate Cancer: A Comparison of Observational Cohorts |
| |
| Authors: | Kate Tilling Hans Garmo Chris Metcalfe Lars Holmberg Freddie C Hamdy David E Neal Jan Adolfsson Richard M Martin Michael Davis Katja Fall J Athene Lane Hans-Olaf Adami Anna Bill-Axelson Jan-Eric Johansson Jenny L Donovan |
| |
| Institution: | 1. Department of Social Medicine, Bristol University, Canynge Hall, Bristol, UK;2. King''s College London, School of Medicine, London, UK; Regional Oncological Centre, Uppsala University, Uppsala, Sweden;3. Division of Clinical Sciences, University of Sheffield, Sheffield, UK;4. Department of Oncology, University of Cambridge, Cambridge, UK;5. Oncological Centre, CLINTEC Department, Karolinska Institutet, Stockholm, Sweden;6. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA;g Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;h Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;i Department of Urology, Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden |
| |
| Abstract: | BackgroundProstate-specific antigen (PSA) measurements are increasingly used to monitor men with localised prostate cancer (PCa), but there is little consensus about the method to use.ObjectiveTo apply age-specific predictions of PSA level (developed in men without cancer) to one cohort of men with clinically identified PCa and one cohort of men with PSA-detected PCa. We hypothesise that among men with clinically identified cancer, the annual increase in PSA level would be steeper than in men with PSA-detected cancer.Design, setting, and participantsThe Scandinavian Prostate Cancer Group 4 (SPCG-4) cohort consisted of 321 men assigned to the watchful waiting arm of the SPCG-4 trial. The UK cohort consisted of 320 men with PSA-detected PCa in the Prostate testing for cancer and Treatment (ProtecT) study who opted for monitoring. Multilevel models describing changes in PSA level were fitted to the two cohorts, and average PSA level at age 50, change in PSA level with age, and predicted PSA values were derived.MeasurementsPSA level.Results and limitationsIn the SPCG-4 cohort, mean PSA at age 50 was similar to the cancer-free cohort but with a steeper yearly increase in PSA level (16.4% vs 4.0%). In the UK cohort, mean PSA level was higher than that in the cancer-free cohort (due to a PSA biopsy threshold of 3.0 ng/ml) but with a similar yearly increase in PSA level (4.1%). Predictions were less accurate for the SPCG-4 cohort (median difference between observed and predicted PSA level: −2.0 ng/ml; interquartile range IQR]: −7.6–0.7 ng/ml) than for the UK cohort (median difference between observed and predicted PSA level: −0.8 ng/ml; IQR: −2.1–0.1 ng/ml).ConclusionsIn PSA-detected men, yearly change in PSA was similar to that in cancer-free men, whereas in men with symptomatic PCa, the yearly change in PSA level was considerably higher. Our method needs further evaluation but has promise for refining active monitoring protocols. |
| |
| Keywords: | Active surveillance Localised prostate cancer PSA doubling time PSA velocity Reference ranges |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
