The relationship between prostate specific antigen change and biopsy progression in patients on active surveillance for prostate cancer

Jared M Whitson, Sima P. Porten, Joan F. Hilton, Janet E. Cowan, Nannette Perez, Matthew R. Cooperberg, Kirsten L. Greene, Maxwell V. Meng, Jeff P. Simko, Katsuto Shinohara, Peter R. Carroll

Research output: Contribution to journalArticle

85 Scopus citations

Abstract

Purpose We assessed whether an association exists between a change in prostate specific antigen and biopsy progression in men on active surveillance. Materials and Methods A cohort of patients undergoing active surveillance for prostate cancer was identified from the urological oncology database at our institution. Multivariate logistic regression was performed to determine whether prostate specific antigen velocity, defined as the change in ln(prostate specific antigen) per year, is associated with biopsy progression, defined as a Gleason upgrade or volume progression on repeat biopsy within 24 months of diagnosis. Results A total of 241 men with a mean ± SD age of 61 ± 7 years and mean prostate specific antigen 4.9 ± 2.2 ng/ml met study inclusion criteria. Median time to repeat biopsy was 10 months (IQR 613). Biopsy progression developed in 55 men (23%), including a Gleason score upgrade in 46 (19%), greater than 33% positive cores in 11 (5%) and greater than 50% maximum single core positive in 12 (5%). The median prostate specific antigen ratio per year was 1.0 (IQR 0.951.03), although 1 man had a ratio of greater than 1.26 (doubled over 3 years) and 7 had a ratio of less than 1/1.26 (halved over 3 years). On multivariate analysis prostate specific antigen doubling within 3 years was associated with a 1.4-fold increase in the odds of biopsy progression (OR 1.4, 95% CI 0.63.4, p = 0.46). Conclusions There is little change in prostate specific antigen during the first 24 months of surveillance in men with well staged, low risk prostate cancer. We believe that these findings highlight the importance of repeat biopsy during surveillance.

Original languageEnglish (US)
Pages (from-to)1656-1660
Number of pages5
JournalJournal of Urology
Volume185
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

Keywords

  • biopsy
  • prostate
  • prostate-specific antigen
  • prostatic neoplasms
  • risk

ASJC Scopus subject areas

  • Urology

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    Whitson, J. M., Porten, S. P., Hilton, J. F., Cowan, J. E., Perez, N., Cooperberg, M. R., Greene, K. L., Meng, M. V., Simko, J. P., Shinohara, K., & Carroll, P. R. (2011). The relationship between prostate specific antigen change and biopsy progression in patients on active surveillance for prostate cancer. Journal of Urology, 185(5), 1656-1660. https://doi.org/10.1016/j.juro.2010.12.042