Rate of PSA Rise Prior to Diagnosis Predicts Risk of Death in Patients with Prostate Cancer
According to a recent article published in The New England Journal of Medicine, men whose PSA increases at a rapid rate in the year prior to diagnosis of prostate cancer have an increased risk of death following a prostatectomy.
Prostate cancer is the most commonly diagnosed cancer in men in the United States. The prostate is a walnut-sized gland that is located between the bladder and the rectum. It is responsible for forming a component of semen. Screening for prostate cancer has become widespread, with the use of prostate specific antigen testing and digital rectal exams. Prostate specific antigen (PSA) is a protein that is normally shed by the prostate and can be measured in the blood. Elevated PSA levels may be used to detect the presence of prostate cancer, detect response to therapy, and/or detect a cancer recurrence following therapy. Recent research has been evaluating the most appropriate “cut-off” PSA levels to use for the screening of prostate cancer. Results from recent studies have indicated that the PSA velocity, or the rate of rise of PSA levels, may be more indicative of the presence of cancer than the PSA level itself.
Researchers from Harvard University recently conducted a clinical study to determine the value of PSA velocity in patients prior to undergoing a prostatectomy (removal of the prostate) and its association with long-term outcomes in these patients. The study included 1,095 men with cancer that had not spread to distant sites in the body (localized prostate cancer), all of whom had undergone a prostatectomy. Variables including PSA level at diagnosis, Gleason score (measurement of the aggressiveness of the cancer), stage of the cancer (extent of spread), and the PSA velocity during the year prior to diagnosis were all evaluated to determine if an association existed between these variables and long-term outcomes with these patients. At a follow-up of over 5 years, men who had a PSA velocity of more than 2.0 ng/ml in the year prior to diagnosis had approximately a 10 times higher risk of death from prostate cancer than men whose PSA velocity was equal to or less than 2.0 ng/ml in the year prior to diagnosis. Men whose PSA velocity was greater than 2.0 ng/ml in the year prior to diagnosis also had a shorter time duration to cancer recurrence and reduced overall survival than men whose PSA velocity was not as rapid. A PSA velocity of 2.0 ng/ml or greater was associated with a higher Gleason score, lymph node metastasis and a higher stage than a PSA velocity of 2.0ng/ml or less in the year prior to diagnosis.
The researchers concluded that men diagnosed with prostate cancer whose PSA velocity is 2.0 ng/ml or greater in the year prior to diagnosis, and wish to undergo a prostatectomy, may also consider the addition of systemic therapy to help improve long-term survival. However, only future clinical trials directly comparing a prostatectomy to a prostatectomy plus systemic therapy in this group of patients will answer the question of whether additional therapy will help improve survival. Patients diagnosed with prostate cancer may wish to speak with their physician about their PSA velocity prior to diagnosis, and their individual risks and benefits of participation in a clinical trial evaluating systemic therapy in addition to local therapy. Two sources of information regarding ongoing clinical trials in the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are performed on behalf of patients at cancerconsultants.com.
Reference: D’Amico A, Chen M-H, Roehl K, Catalona W. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. The New England Journal of Medicine. 2004;351:125-135.
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