UPDATE - Issue 24 - Winter 2005
When the PSA rises. . .
Though radical prostatectomy is always performed with curative intent approximately one third of patients will develop a PSA rise indicative of cancer recurrence within 10 years of their operation. It would be useful to be able to tell such men whether they can be spared intervention or whether they need aggressive additional treatment.
Dr Alan Partin has looked at the survival prospects of such men. He feels that the exquisite sensitivity of the PSA test means that recurrent disease is detected years in advance of symptoms. n fact one study of his patients with PSA relapse showed that a median of eight years passed before they developed metastases, with a further five passing before they died of it.
New aid to decision making
Three risk factors influence the likelihood of such men dying of prostate cancer. Patients are at high or low risk respectively if their cancer was Gleason grade above 8 or below 7; if their PSA rose more or less than 3 years after surgery; or, particularly, whether the timespan over which their PSA level doubled was under 3 or over 15 months. Based on his data, he has developed a table giving the chance of surviving prostate cancer for each combination of these variables.
Useful research tool
A patient's so called PSA doubling time may be a useful way of judging the effectiveness of an intervention in future research as it would be measurable far sooner than their survival.