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- Robinson, David, 1968-, et al.
(author)
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PSA Kinetics Provide Improved Prediction of Survival in Metastatic Hormone-Refractory Prostate Cancer
- 2008
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In: Urology. - : Elsevier BV. - 0090-4295 .- 1527-9995. ; 72:4, s. 903-907
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Journal article (peer-reviewed)abstract
- Objectives: To assess the value of prostate-specific antigen (PSA) kinetics in predicting survival and relate this to the baseline variables in men with metastatic hormone-refractory prostate cancer (HRPC). Methods: The data from 417 men with HRPC were included in a logistic regression model that included hemoglobin, PSA, alkaline phosphatase, Soloway score, and performance status pain analgesic score at baseline. The posttreatment variables included the PSA level halving time after the start of treatment, PSA level at nadir, interval to nadir, PSA velocity (PSAV), PSA doubling time after reaching a nadir, patient age, and treatment. These variables were added to the baseline model, forming new logistic regression models that were tested for net reclassification improvement. Results: The area under the receiver operating characteristics curve for the baseline model was 0.67. Of all variables related to PSA kinetics, the PSAV was the best predictor. The addition of PSAV to the baseline model increased the area under the receiver operating characteristics curve to 0.81. Only a moderate increase in the area under the receiver operating characteristics curve (0.83) was achieved by combining the baseline model in a multivariate model with PSAV, PSA doubling time, interval to nadir, and patient age at diagnosis of HRPC. Conclusions: The PSAV alone gave a better prediction of survival value than all other PSA kinetics variables. By combining PSAV with the variables available at baseline, a better ground for treatment decision-making in men with HRPC can be achieved.
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- Sandblom, Gabriel, et al.
(author)
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Clinical and economic consequences of screening for prostate cancer - the Swedish approach
- 2005
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In: Recent Research Developments in Cancer - årsbok. - Kerala, Indien : Transworld Research Network. - 8178951851 ; , s. 19-35
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Book chapter (other academic/artistic)abstract
- The outcome of two large-scale randomized controlled studies on prostate cancer screening from Europe and the USA are expected within three years. Together with a third large trial already performed in Quebec, Canada, they will hopefully provide some form of evidence for or against screening within the near future, although the results of such studies must be interpreted with caution. The effectiveness of a screening programme depends on the cancer prevalence, demographics, socioeconomic conditions, and treatment traditions in the country where it is performed, which limits the external validity of such studies. The prevalence of prostate cancer is relatively high in Sweden, which theoretically would favour screening. Treatment with curative intent, however, is not as well established as in other countries, despite the fact that the only randomized controlled study published so far with sufficient power to show prolonged cancer-specific survival following radical prostatectomy was performed in Sweden. As watchful waiting is often favoured in Sweden, even for men with localized tumours, the benefit of early detection is reduced. The positive as well as negative economic consequences of prostate cancer screening also have to be considered before a screening programme is started. All these circumstances emphasize the fact that the decision to introduce a screening programme has to be taken at the national level. No study can provide an outcome that can be set as an international standard. Three large trials of prostate cancer screening have been performed in Sweden, but screening on a broad scale has not yet been recommended.
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- Sandblom, Gabriel, et al.
(author)
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Prostate cancer screening.
- 2008
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In: Cancer Causes and Control. - : Springer Science and Business Media LLC. - 1573-7225 .- 0957-5243. ; Jun 3, s. 1411-1411
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Journal article (peer-reviewed)
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| 6. |
- Sandblom, Gabriel, et al.
(author)
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The impact of prostate-specific antigen level at diagnosis on the relative survival of 28,531 men with localized carcinoma of the prostate
- 2008
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In: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 112:4, s. 813-9
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Journal article (peer-reviewed)abstract
- BACKGROUND: To evaluate the predictive value of prostate-specific antigen (PSA) in a population-based cohort, the authors analyzed relative survival in all men with localized prostate cancer who were registered in the Swedish National Prostate Cancer Register (NPCR) from 1996 to 2005. METHODS: All men aged <75 years with localized tumors were identified in the NPCR. A Poisson regression analysis was performed using observed death as response and the expected death rate as offset. The expected and observed numbers of survivors were calculated with stratification for PSA level and 3 categories of tumor differentiation (Gleason score 2-6, 7, and 8-10). The regression model included PSA as linear splines with a breakpoint at a PSA level of 4 ng/mL and with tumor differentiation as a categoric variable. RESULTS: The Poisson regression analysis indicated a U-shaped curve for all 3 groups, with a negative correlation between PSA and relative survival in men with PSA levels <4 ng/mL and a positive correlation for men with PSA levels >4 ng/mL. The correlation was significant for all 3 groups, but the negative correlation between PSA and relative survival was significantly more pronounced in the group with Gleason scores from 8 to 10 than in the other 2 Gleason score groups. CONCLUSIONS: The demonstration of an inverse correlation between PSA level and relative survival in the group of men with PSA levels <4 ng/mL indicated the presence of a small but clinically important subgroup with undifferentiated tumors who have cells that have lost the ability to secrete PSA. This group should be taken into consideration when deciding on treatment and when choosing a cutoff level in PSA screening programs.
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