Prostate Cancer: PSA Change May Be Key to Risk
Researchers Say Tracking PSA Changes Indicates Who's at Risk of Dying When Cancer Returns
Zeroing In on Prostate Cancer Death Risk continued...
"When you put it all together, we are 84% accurate in predicting long-term outcome for these men," Freedland says.
For example, the very worst prediction would be a man whose PSA reappeared in less than three years, whose PSA level doubled in less than three months, and who had a Gleason score of more than 8. Such men have a 51% chance of surviving for five years, a 1% chance of surviving for 10 years, and less than a 1% chance of surviving for 15 years.
The best prediction would be for a man whose PSA reappeared after more than three years, whose PSA level took at least 15 months to double, and whose Gleason score was less than 8. Such men have a 100% chance of surviving for five years, a 98% chance of surviving for 10 years, and a 94% chance of surviving for 15 years.
"The significance of the finding is it can help us identify who needs treatment after surgery recurrence and who doesn't," Freedland says.
Great Information -- but What Can a Man Do About It?
Knowing who is at risk is helpful. But what's missing is knowing exactly what to do about it, says Mitchell S. Anscher, MD, professor of radiation oncology at Duke University Medical Center. Anscher's editorial accompanies the D'Amico and Freedland studies.
"I think the only thing the patient can really take home from this, if they fall into one of the unfavorable categories, is knowing they might not do as well with standard treatment," Anscher tells WebMD. "We cannot yet say whether additional treatment would be more successful -- that has to be studied."
D'Amico and Freedland readily admit this is true.
"We identified who needs treatment, now we need to figure out how to treat them," Freedland says. "There is still a lot we need to do. Even if we told a guy, 'You are in trouble,' we still don't know what to do about it. But at least now we have a good handle on who needs the aggressive treatments."
And what would this aggressive treatment look like? Nobody is sure.
"I would in general urge patients to be cautious and not jump to any conclusions from these studies, or seek to change what they would do," Anscher says. "They are good studies, but they are not going to change the standard of care just yet."