The role of prostate-specific antigen (PSA) and PSA kinetics in the management of advanced prostate cancer

Abstract

Prostate‐specific antigen (PSA) plays an important role in the diagnosis and management of prostate cancer. The utility of PSA has been extended to a number of parameters which may guide clinical decision‐making in subsequent treatment. This book chapter systematically reviewed the current evidence of PSA and PSA kinetics in the management of advanced prostate cancer. Results showed that the prognostic significance of pre‐treatment PSA level is uncertain. PSA nadir predicts survival outcomes but may be confounded by the pre‐treatment PSA level, and the PSA nadir may only be known after there is a PSA rise in subsequent follow‐up. Time to PSA nadir has some prognostic significance but is limited by the potential immortal bias. Evidence on the use of PSA doubling time is limited and the different calculation methodologies render difficulties in generalization of such parameter. PSA progression is the best surrogate marker of survival and can be considered as the primary endpoint in future clinical trials. PSA response predicts survival but has not been shown prospectively to be a surrogate of clinical benefit. PSA and its kinetics should play an important role in the management of advanced prostate cancer and should be utilized in a more standardized manner.