Another study recently published in the New England Journal of Medicine has added more fuel to the ongoing debate surrounding the use of prostate-specific antigen (PSA) and prostate cancer screening (see Continued Questions over PSA Testing and Prostate Cancer Screening for discussion of two other recent studies). In the new study, researchers found evidence that the rate at which the PSA level rises in the body (the PSA velocity) can help predict the risk of death from prostate cancer.

In the study, data were analyzed from 1095 men with localized prostate cancer who were treated with radical prostatectomy. This included their PSA levels from the year prior to diagnosis. Those men whose PSA levels had risen quickly during that year were more likely to die from the cancer. Specifically, those whose PSA levels rose by more than 2.0 ng/mL had significantly shorter times to cancer recurrence and death than those whose PSA velocity was less than 2.0 ng/mL. Also of note, the PSA velocity seemed to be more important than the actual PSA value in predicting a poor outcome.

As a result of their findings, these researchers recommend that men have their PSA level measured starting at age 35 as a baseline and then annually to watch for a sharp rate of increase. In addition, they suggest using this information to help guide treatment decisions. For example, those men whose PSA velocity is 2.0 ng/mL or faster might consider aggressive treatment rather than the more conservative approach of “watchful waiting.”

While this study is significant in its contribution to the continued effort to understand PSA values and appropriate treatment of prostate cancer, further research is needed to validate the findings from this study among a larger, more diverse patient sample. Please be aware that PSA levels also may rise for a short time with prostate infections, after prostate biopsies, and with other prostate diseases.

Sources:
D’Amico, AV et al. “Preoperative PSA Velocity and the Risk of Death from Prostate Cancer after Radical Prostatectomy.” New England Journal of Medicine 2004, Vol. 351 (No. 1), pages 125-135.

Stein, Rob. “Sharp Change in Cancer Test Results May Clarify: Treat Prostate or Wait?” The Washington Post July 8, 2004, pages A1, A6.