Current Role of PSA Kinetics in the Management of Patients with Prostate Cancer

ObjectivesThis review focuses on the ongoing debate over PSA measurement which has only recently incorporated the additional value derived from using PSA kinetics for patient decision-making.MethodsThe authors report on the interest of Prostate Specific Antigen Velocity (PSA-V) and PSA Doubling Time (PSA-DT) in different clinical situations. They exhaustively compiled the most significant papers in the literature dealing with this issue in order to provide a particularly clear overview.ResultsWith regard to screening, using a PSA-V cut-off of 0.1 ng/ml/yr, 81% and 85% of cancers were more correctly identified in the Baltimore study and in the ERSSPC respectively. However, specificity dropped to 50% and 18%. PSA-V may be also a marker of disease biology as PSA-V ≥2 ng/ml/yr is associated with a significantly shorter time to recurrence and death from prostate cancer. PSA-DT may be used to predict treatment outcome prior to definitive therapy. Some authors claim that patients with doubling times >18 months could be managed expectantly as their cancers are likely to remain latent. PSA-DT can be useful as well to distinguish, in patients who experience biological recurrence following surgery, between those who have local recurrence and those who have metastatic disease. PSA-DT can indicate whether or not it is relevant to begin an active treatment in case of a watchful waiting program.ConclusionsIncreasing evidence supports the use of PSA kinetics as a powerful indicator of tumour biology. PSA-V and DT are useful in monitoring disease recurrence and progression following failure of definitive therapy. PSA-V is also an important predictor of death in patients with localized PCA.Determination of PSA kinetics may allow a more rapid and meaningful evaluation of therapeutic strategies.