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Limitations and use of PSA velocity in the diagnosis and characterization of prostate cancer

Nature Clinical Practice Urology volume 4, pages 576–577 (2007)Cite this article

Natural processes, such as global weather and childhood growth, are best understood when the outcome variables, for example temperature or height, are measured over prolonged intervals. Prostate cancer-specific mortality (PCSM), the ultimate outcome variable of definitive treatment, is associated with lymph node involvement, seminal vesicle invasion and specimen Gleason score, but not with single values of preoperative PSA. Measuring PSA values over time—the so called PSA velocity (PSAV)—was proposed as a means to better track the variability of prostatic pathophysiologic states. PSAV is appealing for its simplicity but much debate continues as to its clinical value in the diagnosis and characterization of prostate cancer.

PSA velocity is calculated as the log slope of at least three PSA values plotted over at least 2 years, no less than 6 months apart and measured in ng/ml/year.1 The derived value was considered to take into account biologic and test variability and capture significant clinical progression. In a 5-year longitudinal study of 1,000 men who underwent radical prostatectomy, a PSAV of 2.0 ng/ml/year best predicted time to recurrence, PCSM and overall mortality.2 In fact, up to 28% of men with PSAV >2.0 ng/ml/year died of prostate cancer despite radical prostatectomy and, on multivariate analysis, carried a 10-fold higher risk of death than for patients with PSAV <2.0 ng/ml/year, more so than that of tumor grade, stage or pre-biopsy PSA. While PCSM might be associated with high-grade, high-volume disease, up to half of patients with a PSAV >2.0 ng/ml/year had low-to-intermediate risk covariants (i.e. PSA <10 ng/ml, Gleason score ≤6, and stage cT1c).

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  1. AD Smith is Chief Resident, and JL Phillips is Professor of Urology and Chief of Oncology at Beth Israel Medical Center in New York, NY, USA.,

    Andrew D Smith & John L Phillips

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  1. Andrew D Smith
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  2. John L Phillips
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Correspondence to John L Phillips.

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Smith, A., Phillips, J. Limitations and use of PSA velocity in the diagnosis and characterization of prostate cancer. Nat Rev Urol 4, 576–577 (2007). https://doi.org/10.1038/ncpuro0936

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