ART Management BCR PSA n PSA Doubling Time Commentary
Summary: Phoenix consensus (PSA of 2.0 ng/ml over nadir post RT) is challenged by results showing MET in men testing below this threshold. Use of PSMA PET is suggested to establish MET after BCR after surpassing the Phoenix threshold. Most important was not PSA but PSA doubling time. PSA doubling time 15 months,
The conclusion is that PSA doubling time must be considered along with PSA to determine when men should be scanned. Once PSA is at 2.0 ng/mL, 100% of men are positive. Therefore, PSA doubling time should be used below this threshold to predict and identify potential metastasis early. Journal of nuclear medicine 2001 also presented; ‘Factors that project biochemical recurrence in individuals after radiation therapy.’ It’s a checklist to see who is at risk for BCR.
1) Min 00:45; BCR or PSA failure is 2.0 ng/mL above the nadir post radiation therapy. Phoenix consensus establish 2006.
2) Min 3:23; Jensen European Association of Urology, 2021. Proposes using PSMA PET to establish individual biochemical recurrence below the Phoenix threshold.
3) Min 3:45; 315 men tested 63 were less than the Phoenix threshold. For these 63;
a. Gleason score varied from 6 to 9.
b. Nadir for PSA what 0.1 ng/mL.
c. PSA at scan was 1.3 ng/mL.
d. PSA doubling time was six months.
e. Time from Nadir to scan was 47 months.
4) Min 4:38; in 53 of the 63 men scanned were below the Phoenix threshold;
a. 84.1% were PSMA PET positive
b. 33% local, 50.8% metastatic.
5) Min 5:39; at what PSA level should a PSMA PET be done. Detection rates for PSA values were.
a. Min 6:51; <0.5 ng/ml 39 to 57%
b. 0.5-1.0 ng/ml 63-75%
c. 1.0-2.0 ng/ml 82-95%
6) Journal of nuclear medicine 2001. Factors that project biochemical recurrence in individuals after radiation therapy.
a. High-grade cancer patients with Gleason’s seven or above.
b. PSA of 1.6 ng/mL at scan date.
c. Median doubling time 6.8 months.
d. Negative CT and bone scan.
e. None on ADT treatment.
f. 50 man study.
g. All negative PSMA PET w PSA less than 1.0 ng/mL.
h. Metastasis was noted only with PSA greater than 2.0 ng/mL.
7) Min 9:30; predictions for recurrence, or PSA level and doubling time
a. PSA level greater than 2.0 mg/mL PSMA PET was always positive.
b. Min 10:39; PSA of 2.0 ng/mL had a 15% chance of MET with doubling time of 15 months.
c. Min 10:57; PSA of 2.0 had a 40% chance of MET with a doubling time of six months.
8) Min 10:50; nomogram is presented for use. The conclusion is that PSA doubling time must be considered along with PSA to determine when men should be scanned. Once PSA is at 2.0 ng/mL, 100% of men are positive. Therefore PSA doubling time should be used below this threshold to predict and identify potential metastasis early.
