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PSA Doubling Time - US vs. Std PSA Test
  1. #1
    ron Guest

    Default PSA Doubling Time - US vs. Std PSA Test

    Here's an abstract of a recent article by Peter Carroll comparing PSA doubling times determined by the ultrasensitive and the standard PSA test. I was surprised to read that they can often be quite different and thought others might find this article of interest...ron

    J Urol. 2011 Oct 17. [Epub ahead of print]

    Poor Agreement of Prostate Specific Antigen Doubling Times Calculated UsingUltrasensitive Versus Standard Prostate Specific Antigen Values: ImportantImpact on Risk Assessment.

    Reese AC, Fradet V, Whitson JM, Davis CB, Carroll PR.
    SourceDepartment of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.

    Abstract
    PURPOSE: In men with biochemical recurrence after radical prostatectomy, a rapid prostate specific antigen doubling time is associated with adverse outcomes, and is often used to guide the type and timing of salvage therapy. It is unknown whether prostate specific antigen doubling time calculated inthe ultrasensitive range (prostate specific antigen less than 0.2 ng/ml) accurately reflects measures performed in the traditional range (prostate specific antigen greater than 0.2 ng/ml).

    MATERIALS AND METHODS: We studied 394 men in a national disease registry ofmen with prostate cancer (CaPSURE™) who underwent radical prostatectomy,experienced biochemical failure, and had prostate specific antigen doubling time assessed using ultrasensitive and traditional prostate specific antigen values. Agreement between these measurements was assessed using Cohen'skappa score.

    RESULTS: Median ultrasensitive prostate specific antigen doubling time was 11.9 months (IQR 6-29) and median traditional prostate specific antigen doubling time was 240 months (IQR 18-240). Agreement between ultrasensitive and traditional prostate specific antigen doubling time was poor, with a weighted Cohen's kappa score of 0.04 (95% CI -0.02-0.10). Using a dichotomous prostate specific antigen doubling time cutoff of 9 months, there was a statistically significant difference between ultrasensitive and standard prostate specific antigen doubling time (exact McNemar p <0.01). Ultrasensitive prostate specific antigen doubling time was more or less rapid than traditional prostate specific antigen doubling time by more than 15 months in 244 (62%) and 35 (9%) patients, respectively.

    CONCLUSIONS: Agreement between prostate specific antigen doubling time calculated using ultrasensitive vs traditional prostate specific antigen valuesis poor. Ultrasensitive prostate specific antigen doubling time is often significantly more rapid than traditional prostate specific antigen doublingtime, potentially overestimating the risk of clinical recurrence. Until the significance of ultrasensitive prostate specific antigen doubling time isbetter characterized, the decision to proceed with salvage therapy should not be based on prostate specific antigen doubling time calculated using ultrasensitive prostate specific antigen values.

    PMID:22014796

  2. #2
    I.P. Freely Guest

    Default Re: PSA Doubling Time - US vs. Std PSA Test

    ron wrote:
    > J Urol. 2011 Oct 17. [Epub ahead of print]
    >
    > Poor Agreement of Prostate Specific Antigen Doubling Times...


    I'm going to be all over that one! Thank you. I'll be watching and
    searching for the full text.

    The only comments I've seen to this effect were unsupported references
    to a disparity between ultrasensitive PSAs vs PSAs > 1.0. There's no
    rational doubt my PSA is rising in response to a bona fide source; its
    curve is too long, consistent, and "neat" to be ultrasensitive noise.
    But if my "real" PSADT is years rather than the 15.4 months indicated by
    ultrasensitive assays, there's no way I'm gong to knee-jerk into a
    high-risk, low-benefit (in my case) procedure.

    HOWEVER ... many studies show very clear survival benefits to men who DO
    knee-jerk before they hit 0.2, 0.4, or 0.5, depending on the study and
    its test points.

    I.P.


  3. #3
    [email protected] Guest

    Default Re: PSA Doubling Time - US vs. Std PSA Test

    My oncologist has told me that psa test results at the ultra low end
    are not reliable.

  4. #4
    Steve Kramer Guest

    Default Re: PSA Doubling Time - US vs. Std PSA Test

    Glad to have you back, Bert! It's been almost three years. You were doing
    intermittent ADT as I recall.

    It is true that PSA results under 0.10 are about useless for purposes of
    predicting growth of cancer. It is is very useful for knowing that you are
    safe, but then I feel safe with a standard test and a result of < 0.10.



    PSA OCT 2000 @ 46
    Biopsy NOV 2000 3+4=7, T2c
    RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
    PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
    EBRT MAY - JULY 2002 @ 47
    PSA .34 .22 .15 .21 .32 PSAD 0.56 years
    Lupron started JULY 2003 @ 48
    PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
    Casodex added JUL 2006 @ 51
    PSA <0.1 since Next draw AUG 2012 @ 57
    Illegitimati non carborundum




    wrote in message
    news:[email protected]..

    My oncologist has told me that psa test results at the ultra low end
    are not reliable.


  5. #5
    I.P. Freely Guest

    Default Re: PSA Doubling Time - US vs. Std PSA Test

    On 11/12/11 4:14 PM, [email protected] wrote:
    > My oncologist has told me that psa test results at the ultra low end
    > are not reliable.


    So did one of mine. Another equally qualified expert -- they're both med
    school professors and busy practicioners -- in the same big cancer
    center disagreed.

    And the beat goes on.

    I.P.

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