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PSA Velocity Predicts Prostate Cancer Outcomes

Increases of more than 2.0 ng/mL yearly in PSA levels were significantly associated with prostate cancer mortality.

We need better ways to determine which prostate-specific antigen (PSA)-detected localized prostate cancers are most likely to progress. The rate at which the PSA level rises (i.e., PSA velocity) prior to a diagnosis of prostate cancer is a potential prognostic marker.

This study involved 1095 men with localized prostate cancer who underwent radical prostatectomy but no adjuvant hormonal therapy. All men had undergone more than one PSA level determination before their diagnoses; biopsies were done when PSA levels exceeded 2.5 ng/mL. Most tumors (71%) were detected only by PSA screening. Median follow-up was 5 years.

Annual PSA velocity of more than 2.0 ng/mL was associated significantly with disease recurrence, death from prostate cancer, and death from any cause, compared with lower PSA velocity. For example, 24 of 262 men with annual PSA velocity of more than 2.0 ng/mL, but only 3 of 833 patients with lower PSA velocity, died from prostate cancer. In multivariable analysis, PSA velocity, PSA level at diagnosis, Gleason score on biopsy, and tumor stage at diagnosis all were significant predictors of death from prostate cancer.

Comment: In this study, PSA velocity before diagnosis of prostate cancer discriminated quite impressively between ultimately fatal and nonfatal cancers. The next challenge -- best addressed by randomized trials -- will be to determine whether this information can be used to inform treatment decisions.

— Allan S. Brett, MD

Published in Journal Watch General Medicine July 13, 2004

Citation(s):

D'Amico AV et al. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004 Jul 8; 351:125-35.

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