PSA Velocity Decades Before Prostate Cancer Diagnosis Associated With Decreased Survival

UroToday.com - A serum PSA increase of 2 ng/ml or greater the year before prostate cancer diagnosis has recently been associated with a higher risk of prostate cancer elated death. The association between cancer-related death and PSA velocity decades before diagnosis (with values significantly below 4.0 ng/ml) has not been well established.

In the November 1st issue of the Journal of the National Cancer Institute, Carter and colleagues from Johns Hopkins present interesting data obtained prospectively though the Baltimore Longitudinal Study of Aging.

Serum PSA velocity was calculated in a cohort of men followed for at least 39 years in the Baltimore Longitudinal Study. PSA measurements and rectal examination results were available for most patients since 1991. PSA determinations before 1991 were performed on frozen sera collected prospectively.

Of 980 men with serum PSA levels available, 20 had subsequently died of prostate cancer, 104 were alive with prostate cancer or had died of other causes, and 856 did not have a history of prostate cancer.

Interestingly, serum PSA velocity 10-15 years before diagnosis was associated with prostate cancer survival 25 years later. Those patients with a PSAv less than 0.35 ng/ml/year had a 25-year cancer-specific survival of 92%, compared to 54% in patients with a PSAv > 0.35 ng/ml/year. Prostate cancer related death was significantly greater (Hazard ratio 4.7, 95% CI 1.3 to 16.5) in patients with a PSAv greater than 0.35 ng/ml/year, with a mortality rate of 1240 men per 100,000 person-years compared with 140 men per 100,000 person-years in patients with a PSAv less than 0.35 ng/ml/year.

These data suggest that a PSA velocity greater than 0.35 ng/ml per year decades before prostate cancer diagnosis may be associated with subsequent prostate cancer death even when serum PSA levels are considered “normal”.

H. Ballentine Carter, Luigi Ferrucci, Anna Kettermann, Patricia Landis, E. James Wright, Jonathan I. Epstein, Bruce J. Trock, E. Jeffrey Metter

J Natl Cancer Inst 2006;98:1521 - 7.
Reviewed by UroToday.com Contributing Editor Ricardo F. SГЎnchez-Ortiz, MD

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