High pre-treatment PSA velocity predicts worse outcome

A pre-treatment rate of PSA velocity of more than 2.0 ng/mL per year is strongly associated with a high risk of death from prostate cancer, a study to be published in the July 1 issue of Cancer suggests. Elevated PSA velocity was a stronger poor prognostic factor than any other single high-risk indicator, such as a biopsy Gleason score greater than 7, a PSA level of 10.0 ng/mL, or an advanced disease category.

In the study, Anthony D'Amico, MD, of Boston's Brigham and Women's Hospital, and colleagues characterized PSA velocity significant in prostate cancer-specific mortality (PCSM) rates following treatment with radical prostatectomy or radiation therapy. The team reviewed data from 948 men with localized prostate cancer who had one or more high-risk factors.

They found that the most important single prognostic factor was PSA velocity. As expected, men who had multiple risk factors died from their disease significantly earlier than those with one factor. Of the men who underwent treatment with radical prostatectomy or radiation therapy, 44% and 28%, respectively, had pre-treatment PSA velocities of >2 ng/mL per year as their only identified high-risk factor. Of those men who died with only one identified high-risk factor, 88% of prostatectomy-treated patients and 80% of radiation therapy-treated patients had pre-treatment PSA velocities of >2 ng/mL per year.

In identifying this association, the authors also point out that other studies have found that time to death shortens as PSA velocity increases. This suggests that further research should examine stratified PSA velocities to assess risk in men with localized disease.

"These findings highlight the ability of a pre-treatment PSA velocity >2 ng/mL/year alone to identify men with aggressive prostate cancer and in whom effective systemic treatment in addition to monotherapy with RP or RT is needed to decrease PCSM rates," the authors wrote.