Current strategies for monitoring men with localised prostate cancer lack a strong evidence base: observational longitudinal study
| Autor: | C, Metcalfe, K, Tilling, M, Davis, J A, Lane, R M, Martin, H, Kynaston, P, Powell, D E, Neal, F, Hamdy, J L, Donovan, Debbie, Cooper |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Longitudinal study Nice Reference range urologic and male genital diseases Prostate cancer PSA Reference Values Internal medicine Clinical Studies medicine Humans Longitudinal Studies computer.programming_language Aged Gynecology PSA Velocity business.industry Cancer Prostatic Neoplasms Middle Aged Prostate-Specific Antigen medicine.disease Prostate-specific antigen Oncology disease management kinetics Observational study business computer |
| Zdroj: | British Journal of Cancer |
| ISSN: | 1532-1827 |
| Popis: | Background: The UK National Institute for Health and Clinical Excellence (NICE) guidance recommends conservative management of men with ‘low-risk' localised prostate cancer, monitoring the disease using prostate-specific antigen (PSA) kinetics and re-biopsy. However, there is little evidence of the changes in PSA level that should alert to the need for clinical re-assessment. Methods: This study compares the alerts resulting from PSA kinetics and a novel longitudinal reference range approach, which incorporates age-related changes, during the monitoring of 408 men with localised prostate cancer. Men were monitored by regular PSA tests over a mean of 2.9 years, recording when a man's PSA doubling time fell below 2 years, PSA velocity exceeded 2 ng ml–1 per year, or when his upper 10% reference range was exceeded. Results: Prostate-specific antigen doubling time and PSA velocity alerted a high proportion of men initially but became unresponsive to changes with successive tests. Calculating doubling time using recent PSA measurements reduced the decline in response. The reference range method maintained responsiveness to changes in PSA level throughout the monitoring. Conclusion: The increasing unresponsiveness of PSA kinetics is a consequence of the underlying regression model. Novel methods are needed for evaluation in cohorts currently being managed by monitoring. Meanwhile, the NICE guidance should be cautious. |
| Databáze: | OpenAIRE |
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