Changes of prostate-specific antigen levels (PSADT, PSAV) as a prognostic factor in prostate cancer

This article is an attempt to present a contemporary view on the role of PSA kinetic levels defined as PSA doubling time (PSADT) and PSA velocity (PSAV) in the decision-making process. Evaluation of PSA kinetics in early diagnosis of prostate cancer could be a method which allows the diagnosis of cancer to be made many years before the diagnosis based on a single PSA determination. Thus, introduction of PSA kinetics into the decision algorithm apart from single PSA determination is reasonable. In a group of patients after radical prostatectomy PSADT might be a very early endpoint which could replace cause-specitic survival as a late endpoint. Patients with short PSADT should be regarded as a group for which application of hormonal therapy should be considered. PSADT allows one to distinguish subgroups of patients with higher risk for distant metastases and death caused by prostate cancer, which could determine a change of treatment strategy for these patients. For patients after radical radiotherapy connection of the PSADT value with the nadir of PSA after radiotherapy increase, the predictive power in defining risk of distant metastases. PSAV above 2 ng/ml before radiotherapy treatment is connected with higher risk (12-fold) of death due to prostate cancer for patients after radiotherapy. In addition, PSADT is one of the most important parameters describing aggressiveness of the disease. PSA level alone above the proposed cut-off level is a less important factor predicting the risk of death from prostate cancer than PSA kinetics defined as PSADT . However, the final answer concerning the practical usefulness of PSADT and PSAV can only be confirmed by performing randomized clinical trials in which also PSADT and PSAV cut-off levels should be defined.