April 16, 2007 — A study shows that while prostate-specific antigen (PSA) measurement remains an important monitoring tool, it performs poorly in distinguishing those who will develop lethal prostate cancer from those at low or no risk of disease progression. The results are reported in the April 4 issue of the Journal of the National Cancer Institute, where the authors call for better decision-making tools for active monitoring of patients with early disease.
"In this study, both baseline PSA and rate of change in PSA during the first 2 years of follow-up carried prognostic information," write Katja Fall, MD, PhD, from the Karolinska Institutet in Stockholm, Sweden, and colleagues. "However, despite extensive exploration of different statistical models, we could not substantiate any PSA curve characteristic as a good classifier of who would develop lethal disease and who would not."
In an accompanying editorial, Dipen J. Parekh, MD, from the University of Texas Health Science Center in San Antonio, and colleagues point out that the patients in the current study were substantially different from most patients with localized prostate cancer today in countries where PSA screening is highly prevalent, such as the United States. "PSA levels were above 10 ng/mL in 48% of the patients in that population and more than 60% of men had tumors that were palpable on rectal examination," they write. "
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