title: Significance of preoperative PSA velocity in men with low serum PSA and normal DRE.
abstract: OBJECTIVE
  A PSA velocity (PSAV)>0.35 ng/ml/year approximately 10-15 years prior to diagnosis is associated with a greater risk of lethal prostate cancer. Some have recommended that a PSAV>0.35 ng/ml/year should prompt a prostate biopsy in men with a low serum PSA (<4 ng/ml) and benign DRE. However, less is known about the utility of this PSAV cutpoint for the prediction of treatment outcomes among men undergoing radical prostatectomy (RP).
  
  
  METHODS
  Between 1992 and 2007, 339 men underwent RP at our institution with a preoperative PSA<4 ng/ml, benign DRE, and multiple preoperative PSA measurements. PSAV was calculated by linear regression analysis using all PSA values within 18 months prior to diagnosis. Kaplan-Meier survival analysis was performed, and biochemical progression rates were compared between PSAV strata using the log-rank test.
  
  
  RESULTS
  The preoperative PSAV was >0.35 ng/ml/year in 124 (36.6%) of 339 men. Although there were no significant differences in clinico-pathological characteristics based upon PSAV, men with a PSAV>0.35 ng/ml/year were significantly more likely to experience biochemical progression after RP at a median follow-up of 4 years (P=0.022).
  
  
  CONCLUSIONS
  In this low-risk population with a preoperative PSA<4 ng/ml and benign DRE, approximately 1/3 had a preoperative PSAV>0.35 ng/ml/year. Physicians should carefully monitor men with a preoperative PSA>0.35 ng/ml/year as they are at increased risk of biochemical progression following RP.
authors.affiliation: Department of Urology and The Section on Value and Comparative Effectiveness, New York University School of Medicine, New York, NY, USA.
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magheli
authors.forename: Kevin
authors.initials: K
authors.lastname: Zhao
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Humphreys
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gonzalgo
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: Misop
authors.initials: M
authors.lastname: Han
mesh_terms: D051517:Digital Rectal Examination; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen