May 11th, 2010

PSA Changes May Provide Limited Information during Active Surveillance for Low-risk Prostate Cancer


In a study of men with low-risk prostate cancer undergoing active surveillance, prostate-specific antigen (PSA) velocity and doubling time did not reliably identify cancer progression. These findings were recently published in the Journal of Clinical Oncology.

Treatment of early-stage prostate cancer may involve surgery, radiation therapy, or no treatment until the cancer progresses (active surveillance/watchful waiting).

During active surveillance, men are often closely monitored in order to detect prostate cancer progression. Monitoring may include a periodic PSA blood test and digital rectal exam in addition to repeat biopsies of the prostate. In an effort to help men avoid the need for repeat biopsies, researchers have searched for other, less invasive measures of cancer progression.

In the current study, researchers evaluated PSA levels in 290 low-risk prostate cancer patients undergoing active surveillance in order to determine whether or not certain measures of PSA change (PSA velocity and PSA doubling time) could accurately identify prostate cancer progression. Active surveillance included PSA measurement and digital rectal exam every six months plus annual biopsy.

  • After an average follow-up of 2.9 years, 35% of the men on active surveillance had an unfavorable biopsy result and were recommended to undergo treatment.
  • Postdiagnosis PSA velocity and PSA doubling time were not highly correlated with biopsy result.

The researchers concluded that for men with low-risk prostate cancer undergoing active surveillance, regular surveillance biopsy remains important for detecting cancer progression. It should be noted, however, that this study was relatively small and conducted at a single institution, which may limit the generalizability of these results.


Ross AE, Loeb S, Landis P, et al. Prostate-Specific Antigen Kinetics During Follow-Up Are an Unreliable Trigger for Intervention in a Prostate Cancer Surveillance Program. Journal of Clinical Oncology. [early online publication] May 3, 2010.


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