PSA density (PSAd) kinetics strongly predict pathologic progression on prostate cancer active surveillance (AS), investigators reported at SUO 2020, the virtual meeting of the Society of Urologic Oncology.
In a cohort of 1290 patients on AS at Massachusetts General Hospital during 1997 to 2016, 453 men initially had Gleason Grade Group 1 disease. At a median 3.3 years after diagnosis, 137 men (30.2%) experienced progression upon follow-up biopsy, and 162 (35.8%) underwent treatment. Although PSAd values varied during AS, patients who progressed generally had higher values.
In adjusted analyses, PSAd kinetics significantly associated with biopsy grade-progression, a team led by Adam S. Feldman, MD, of Massachusetts General Hospital in Boston, Massachusetts, reported. Patients with PSAd higher than 0.16 ng/mL2 (fourth quartile) had a 4-fold greater risk for progression than patients with PSAd 0 to 0.073 ng/mL2 (first quartile). Adding PSAd kinetics or PSAd to a model significantly improved prediction, – the investigators noted
“PSad values greater than 0.15 ng/mL2 at any time during AS should alert the treating physician to utilize close scrutiny and consider repeat biopsy,” Dr Feldman and his colleagues concluded in their poster presentation. “The components of PSAd are already part of routine AS protocol, so monitoring PSAd over time confers no additional cost or burden to the patient and can be easily integrated into clinical practice to improve risk stratification for men with prostate cancer.”
Gusev A, Rumpf F, Zlatev D, et al. PSA density kinetics predict grade progression on prostate cancer active surveillance. Presented at: SUO 2020, December 3-5, 2020. Poster 167.