Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability.
BACKGROUND
Prostate-specific antigen (PSA) level is typically used as a dichotomous test for prostate cancer, resulting in overdiagnosis for a substantial number of men. The rate at which serum PSA levels change (PSA velocity) may be an important indicator of the presence of life-threatening disease.


METHODS
PSA velocity was determined in 980 men (856 without prostate cancer, 104 with prostate cancer who were alive or died of another cause, and 20 who died of prostate cancer) who were participants in the Baltimore Longitudinal Study of Aging for up to 39 years. The relative risks (RRs) of prostate cancer death and prostate cancer-specific survival stratified by PSA velocity were evaluated in the three groups of men by Cox regression and Kaplan-Meier analyses. Statistical tests were two-sided.


RESULTS
PSA velocity measured 10-15 years before diagnosis (when most men had PSA levels below 4.0 ng/mL) was associated with cancer-specific survival 25 years later; survival was 92% (95% confidence interval [CI] = 84% to 96%) among men with PSA velocity of 0.35 ng/mL per year or less and 54% (95% CI = 15% to 82%) among men with PSA velocity above 0.35 ng/mL per year (P<.001). Furthermore, men with PSA velocity above 0.35 ng/mL per year had a higher relative risk of prostate cancer death than men with PSA velocity of 0.35 ng/mL per year or less (RR = 4.7, 95% CI = 1.3 to 16.5; P = .02); the rates per 100,000 person-years were 1240 for men with a PSA velocity above 0.35 ng/mL per year and 140 for men with a PSA velocity of 0.35 ng/mL per year or less.


CONCLUSIONS
PSA velocity may help identify men with life-threatening prostate cancer during a period when their PSA levels are associated with the presence of curable disease.
Carter
H Ballentine
HB
Department of Urology, Marburg 403, Johns Hopkins School of Medicine, 600 N Wolfe St., Baltimore, MD 21287, USA. hcarter@jhmi.edu
Ferrucci
Luigi
L
Kettermann
Anna
A
Landis
Patricia
P
Wright
E James
EJ
Epstein
Jonathan I
JI
Trock
Bruce J
BJ
Metter
E Jeffrey
EJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D012372:ROC Curve; D012107:Research Design; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D017430:Prostate-Specific Antigen