Especially in the case of prostate cancer, not all cancer treatments and diagnostic procedures enhance a patient’s long-term survival in the same way.
A research team from the University of California, Los Angeles has determined that using PSA level recurrence to determine overall survival may not be the greatest indicator of improved health or extended life.
The study was published on August 28 in the Journal of Clinical Oncology.
Despite being a tool for early prostate cancer detection, the continuous detection of PSA, or prostate-specific antigen, levels after prostate cancer treatment may not have a significant impact on comprehending a person’s overall survivability.
How to understand PSA
PSA, or prostate-specific antigen, is a protein produced by both normal and cancerous prostate cells.
Biochemical recurrence is the theory that, following treatment for prostate cancer, some cancer cells may survive and cause PSA levels to rise.
Despite the patient’s lack of symptoms, this rise in PSA may indicate that the malignancy has not completely disappeared or has reemerged.
Dr. Ruchi Talwar, Urologic Oncology Fellow at Vanderbilt University Medical Center in Nashville, Tennessee, explained: “In other words, a patient’s PSA blood level indicates that their prostate cancer has returned, but imaging and scans show no evidence of cancer anywhere in the body. This typically occurs when the amount of cancer is too small for our current imaging to detect.” Talwar was excluded from the study.
What the investigation discovered
The UCLA research group analyzed information from 11 clinical trials involving 10,741 patients. The researchers examined biochemical recurrence in these prostate cancer patients to determine whether there was a link between this recurrence, its treatment, and overall survivability.
Theoretically, recurrence appears to be a promising indicator for determining if cancer has returned; however, there is insufficient evidence to support its utility in predicting the overall survivability of patients with prostate cancer.
The authors of the study observe that biochemical recurrence should not be a primary endpoint when developing treatments for prostate cancer.
Instead, “metastasis-free survival remains an appropriate endpoint for prospective trials related to radiation therapy in localized disease,” the study found.
Talwar explains, “PSA blood tests are one tool that doctors can use to screen for prostate cancer.”
Antigen specific to the prostate is a protein produced by the prostate organ. PSA levels are detectable even in a healthy prostate. However, when PSA levels rise, it alerts clinicians to the possibility of prostate cancer or prostate cells that are proliferating.
How PSA works to determine therapy
Some men diagnosed with prostate cancer undergo radiation therapy or even surgery to treat the disease.
Dr. Amar Kishan, associate professor of radiation oncology at the David Geffen School of Medicine at UCLA and senior author of the study, stated, “PSA as a biomarker of treatment response is actually extremely useful and is one of the best markers in oncology, especially since all recurrences are associated with an increase in PSA.”
Traditionally, after treatment for prostate cancer, PSA levels drop markedly and, ideally, become undetectable.
“After treatment, PSA blood tests are used to monitor for prostate cancer recurrence, which is the return of active cancer after treatment, and in certain circumstances, PSA blood [tests]are used to determine if additional treatment is necessary, such as radiation therapy soon after surgery,” Talwar told Healthline.
The next stage in routine follow-up would be to undergo imaging investigations. However, it is not always detectable by imaging, and an increase in PSA can be one of the earliest indicators of recurrence.
Recurrence of prostate cancer therapies
After biochemical recurrence, the most common treatments are salvage radiation therapy and androgen deprivation therapy.
Salvage radiation therapy is a treatment whose objective is to prevent and delay metastasis through localized control.
PSA levels can be decreased through androgen deprivation therapy or hormonal injections.
However, it is known whether or not these vaccines help individuals live longer. In addition, they can cause adverse effects such as bone loss and increase the risk of developing diabetes.
Talwar explains that “PSA surveillance can be a useful tool,” but it is by no means flawless. She advises and suggests additional investigation in this area to better comprehend its application.
Not all relapses are fatal, according to Kishan.
Using the findings of his study, he claims, can aid not only in the design of clinical trials, but also in the comprehension of endpoints and their potential implications for survivability.
Numerous biochemical recurrence-related investigations focus on survivability. Nonetheless, another metric that should be investigated is quality of life, although the majority of studies have not examined this outcome.
The University of California, Los Angeles research team has determined in a new study that using PSA level recurrence to determine overall survival may not be the greatest indicator of feeling better or living longer.
Source: Health Line