High PSA velocity linked with low survival rates

The rate at which prostate-specific antigen levels change may help identify men with life-threatening prostate cancer, according to a study in the November 1 issue of the Journal of the National Cancer Institute .

The prostate-specific antigen (PSA) test is often used to screen for prostate cancer, but results often lead to treating cancers that would never have become life threatening, called overdiagnosis. Researchers are interested in finding a way to improve the test and avoid unnecessary overtreatment. Some studies have suggested that PSA velocity, the rate that PSA increases or decreases, is higher in men with life threatening prostate cancer than men without the disease.

H. Ballentine Carter, M.D., of the Johns Hopkins School of Medicine in Baltimore, Md., and colleagues assessed the PSA velocity of 104 men diagnosed with prostate cancer who had not died from the disease, 20 men who died of prostate cancer, and 856 without prostate cancer. Subjects were participants in the Balitmore Longitudinal Study of Aging.

The authors found that a patient's PSA velocity 10-15 years before their cancer diagnosis was associated with survival 25 years later. Patients with a lower PSA velocity had a 92% survival rate, while patients with a higher PSA velocity had a 54% survival rate. Men with a higher PSA velocity also had a higher relative risk of death from prostate cancer (1,240 per 100,000 person-years) than men with a low PSA velocity (140 per 100,000 person-years).

"Our data provide a further argument for PSA testing that begins relatively early in life, when PSA levels are usually lower and prostate enlargement is absent, to establish a baseline for evaluating future changes in PSA levels," the authors write.

In an accompanying editorial, Timothy R. Church, Ph.D., of the University of Minnesota School of Public Health in Minneapolis, discusses the implications of the study's findings. "As it is," he writes, "this study encourages optimism about the value of PSA velocity in predicting outcomes for prostate cancer, although some of the optimism about the value of PSA velocity in predicting outcomes for prostate cancer may be unwarranted due to [certain] study insufficiencies."

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Contacts:

  • Article: Jeff Ventura, 410-955-7832, jventur4@jhmi.edu

  • Editorial: Timothy Church, trc@cccs.umn.edu

    Citations:

  • Article: Carter HB, Ferrucci L, Kettermann A, Landis P, Wright EJ, Epsitein JI, et al. Detection of Life-Threatening Prostate Cancer With Prostate-Specific Antigen Velocity During a Window of Curability. J Natl Cancer Inst 2006;98: 1521-1527.
  • Editorial: Church TR. Prostate-Specific Antigen and Prostate Cancer Diagnosis. J Natl Cancer Inst 2006; 98:1509-1510.

    Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jncicancerspectrum.oxfordjournals.org/.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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