Tilling, K., Garmo, H., Metcalfe, C. et al. (12 more authors) (2010) Development of a new method for monitoring prostate-specific antigen changes in men with localised prostate cancer: A comparison of observational cohorts. European Urology, 57 (3). pp. 446-452. ISSN 0302-2838
Abstract
Background Prostate-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.
Objective To 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 participants The 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.
Measurements PSA level.
Results and limitations In 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).
Conclusions In 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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2009 European Association of Urology. Published by Elsevier B.V. This is an author produced version of a paper subsequently published in European Urology. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Active surveillance; Localised prostate cancer; PSA doubling time; PSA velocity; Reference ranges |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Clinical Sciences Division North (Sheffield) > Clinical Science Centre (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 18 Nov 2019 14:08 |
Last Modified: | 18 Nov 2019 14:08 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.eururo.2009.03.023 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:152632 |