PSA Velocity Over 2 NG/ML Year Pre Diagnosis Independently Predicts Prostate Cancer Mortality In Men Treated With Radical Prostatectomy/Radiotherapy

UroToday.com - In the past, prostate cancer risk stratification before definitive treatment had been largely based on preoperative serum PSA, Gleason score, clinical stage, and the percent of positive biopsies on biopsy. Recently, PSA velocity before diagnosis has been increasingly implicated in prostate cancer prognosis.

In the December supplement of the Journal of Urology, D'Amico, Catalona and colleagues present data from 1453 men with clinical stage T1-T2 cancer treated either with radical prostatectomy (1095) or external beam radiotherapy (358) over a 12 year period at Barnes Jewish Hospital or Harvard Medical School, respectively. Prostate cancer-related mortality was assessed and compared with preoperative variables. Median follow-up was 5 years for the surgical group and 4 years for the radiotherapy group.

A pre-treatment PSA velocity greater than 2 ng/ml/year was independently associated with an increased risk of dying of prostate cancer in men treated with radical prostatectomy (Hazard ratio 12, 95% CI 3 to 51) and radiotherapy (HR: 12, 95% CI 3 to 54). Interestingly, in the cohort of 947 patients with low-risk prostate cancer (77% clinical stage T1 disease, 100% Gleason score 6 or less) those patients with a PSA velocity > 2 ng/ml per year exhibited a 7-year actuarial risk of prostate cancer death of 5% after surgery and 19% after RT, compared with 0.5% and 0% in those with a PSAv < 2 ng/ml/year, respectively.

These data adds to the growing body of evidence suggesting that patients with what had been traditionally considered "low risk" prostate cancer should be treated as high risk patients if their PSA velocity before diagnosis is greater than 2 ng/ml/year.

Anthony V. D'Amico, Ming Hui-Chen, Andrew A. Renshaw, Brenda Sussman, Kimberly A. Roehl, William J. Catalona

J Urol. 2006 Dec;176(6)Supplement:S11-15

Reviewed by UroToday.com Contributing Editor Ricardo Sбnchez-Ortiz, MD

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