What is the possible role of PSA doubling time (PSADT) and PSA velocity (PSAV ) in the decision-making process to initiate salvage radiotherapy following radical prostatectomy in patients with prostate cancer?

摘要

This article is an attempt to present a contemporary viewon the role of the kinetics of PSA levels as defined by PSAdoubling time (PSADT) and PSA velocity (PSAV) in thedecision-making process to initiate salvage radiotherapyin patients with prostate cancer after radical prostatectomy(RP).The dynamics of the rise of PSA levels may be an earlyendpoint parameter, preceding the diagnosis of distantmetastasis or death due to prostate cancer based on asingle PSA determination. Thus, it seems reasonable toinclude the kinetics of PSA levels, apart from single PSAdetermination, in the decision-making algorithm.In a group of patients after RP, PSADT might be an earlyendpoint that could replace cause-specific survival rateas a late endpoint. PSADT allows distinguishing subgroupsof patients at high risk of distant metastases and death,which in turn may lead to a change in the further treatmentstrategy. Therefore, patients with short PSA doublingtime should become a subgroup, in which hormonaltherapy should be considered. To date, there is no unanimousconsent to accept the criteria of assessment of thedynamics of PSA levels as determinants of treatment incase of recurrences following RP. However, a number ofnon-randomized clinical trials in patients after RP suggestit would be useful to include these parameters in thedecision-making process. For instance, a relationship wasfound between increased PSA velocity (>2 ng/mL/year)before initiation of oncological treatment and increased(12-fold) risk of death. A number of well-documented retrospectiveanalyses show that PSADT is one of the mostimportant parameters to describe the disease aggressiveness.It has to be stressed that single determination ofPSA levels is much less precise in terms of describing thebiological aggressiveness of prostate cancer than PSADT.Of course, the question regarding the need to includethe PSA levels kinetic parameters as crucial elementsof patient management algorithms can be answered ina definitive manner only by randomized clinical trials.