May 31, 2007— According to urologist William Catalona, MD, for men under age 60, a PSA velocity threshold of 0.4 ng/ml/year is a significant independent predictor of prostate cancer detection, and the traditional cutpoint of 0.75 ng/ml/year is too high. Does this hold true also for men above the age of 60?
"There is limited information on the performance characteristics of various PSAV thresholds for prostate cancer detection in other age groups," Catalona says in a presentation made in a poster session at the annual meeting of the American Urology Association. Catalona and colleagues from 3 institutions -- Georgetown University School of Medicine, Washington, DC and Washington University School of Medicine, St. Louis, MO and Northwestern Feinberg School of Medicine, Chicago, IL-- designed a new study to find out whether PSA velocity for prostate cancer detection is affected by age.
Extracting data from a large prostate cancer screening study, they looked at age and PSA velocity for 13,619 men including 230 (2%) men aged 40-49, 3448 (25%) men in their 50s, 5778 (42%) men in their 60s, and 4159 (31%) aged 70 and above. PSA measurements and digital rectal examination were performed for these men every 6- to 12- months, and prostate biopsy was recommended for a PSA level greater than 2.5 ng/ml (prior to 1995) or 4.0 ng/ml (after 1995), or findings suspicious for cancer on digital rectal examination.
PSAV was calculated using PSA values from the year prior to diagnosis (in men with prostate cancer), or using the PSA values from the final year in the study (for men without prostate cancer).
"Prostate cancer was detected in 1101 (8%) of 13,619 men," Catalona writes. "Table 1 shows that the significant association between PSA velocity and prostate cancer detection is maintained in men of all ages."
This study, the authors state, showed that PSA velocity "is significantly higher in men of all ages with prostate cancer compared to those without prostate cancer," although analysis showed that PSAV is a stronger indicator of prostate cancer in younger men. "Interestingly, the median PSAV in men with prostate cancer was less than 0.75 ng/ml/year regardless of age, suggesting that this threshold may be too high. Overall, this data confirms that PSA velocity is a useful tool for prostate cancer detection."
Source: AUA 2007 abstract [1420]; Authors: Stacy Loeb, MD, Kimberly A Roehl, MPH, William J Catalona, MD, Robert B Nadler, MD.
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