BERKELEY, CA (UroToday.com) - Rapid prostate specific antigen velocity (PSAV) is associated with worse survival following local therapy for prostate cancer (CaP).

Rapid PSAV prior to therapy is also associated with adverse pathologic features including higher Gleason score, seminal vesicle invasion, pelvic lymph node metastasis, time to PSA recurrence, CaP specific and all-cause mortality after surgery or radiotherapy. In this November 1, 2007 Cancer publication, Dr. Punglia and associates of Dr. Anthony D’Amico evaluated whether the PSAV during the 1.5 years before prostate biopsy was associated with CaP detection and grade the diagnosis in men with PSA levels >4ng/ml.

Between 1989 and 2003, 914 men with a PSA level >4ng/ml, clinical stage T1c, and at least 2 PSA measurements at 1 of 9 Center for Prostate Disease Research (CPDR) sites were included in the study cohort. Of these men, 541 men were diagnosed with CaP. Each of the participants had at least 2 pre-biopsy PSA levels at least 6 months apart and within 18 months of diagnosis. The PSAV was calculated by linear regression from these values. In the statistical analysis, three dependent outcomes were examined using multivariable regression; cancer versus no cancer, cancer with biopsy Gleason scores from 2 to 6 versus no cancer, and cancers with biopsy Gleason scores from 7 to 10 versus either Gleason scores <6 or no cancer. Covariates included a variety of continuous and categorical variables.

A total of 167 of the 541 men had Gleason score 7-10 CaP. An increasing PSA velocity was associated with Gleason score 7-10 disease versus Gleason score 2 to 6 or no cancer. This association was not found for men with Gleason score 2-6 CaP or for any CaP. Interestingly, PSA level was associated with the detection of any CaP and Gleason score <6 CaP but in the presence of PSAV, PSA no longer remained independently predictive for high-grade CaP. These data suggest that PSAV may be a predictor for the diagnosis of high-grade CaP.

Punglia RS, Cullen J, McLeod DG, Chen Y, D'Amico AV

Cancer. 110(9):1973-8, November 2007
doi:10.1002/cncr.23014

PubMed Abstract
PMID:17886252

UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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