Outcomes/Effectiveness Research

Doubling of PSA blood levels after prostate cancer treatment is linked with an increased risk of death from prostate cancer

An increase in levels of prostate specific antigen (PSA) in the blood following treatment for localized prostate cancer with surgery or radiation often indicates the presence of residual cancer and the eventual development of metastatic cancer. A new study quantifies the risk of dying of prostate cancer with levels of increased PSA following treatment for localized prostate cancer.

The researchers calculated that men treated for localized prostate cancer (either surgery or radiation) whose PSA levels double more frequently than every year are at increased risk of dying of prostate cancer within 10 years of diagnosis. By plotting PSA values over time on a log-linear scale, patients and their doctors should be able to predict the likelihood of recurrent prostate cancer, suggests Peter C. Albertsen, M.D., of the University of Connecticut Health Center.

In a study supported in part by the Agency for Healthcare Research and Quality (HS09578), Dr. Albertsen and his colleagues examined the association between posttreatment PSA levels and the risk of dying from prostate cancer in a group of 1,136 men diagnosed with localized prostate cancer between 1990 and 1992. The men had been treated with surgery or radiation with or without androgen withdrawal therapy. PSA recurrence followed a log-linear pattern over time. Patients who died of prostate cancer within 10 years of diagnosis had a median PSA doubling time of 0.8 years (indicating an aggressive cancer), while those who had not died either had no posttreatment increase in serum PSA (40 percent of men studied) or had a PSA doubling time longer than 1 year (44 percent). PSA doubling times were independent of treatment type.

This study confirms that PSA doubling times are correlated with diagnostic tumor stage and grade, but they do not appear to be correlated with patient age at diagnosis. Prostate cancers in older men appear to progress at the same rate as in younger men.

See "Validation of increasing prostate specific antigen as a predictor of prostate cancer death after treatment of localized prostate cancer with surgery or radiation," by Dr. Albertsen, James A. Hanley, Ph.D., David F. Penson, M.D., and Judith Fine, in the June 2004 Journal of Urology 171, pp. 2221-2225.

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