© The Author 2006. Published by Oxford University Press.
ARTICLE |
Detection of Life-Threatening Prostate Cancer With Prostate-Specific Antigen Velocity During a Window of Curability
Affiliations of authors: Departments of Urology (HBC, AK, PL, EJW, BJT) and Pathology (JIE), The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD; National Institute on Aging, National Institutes of Health, Clinical Research Branch, Baltimore, MD (LF, EJM)
Correspondence to: H. Ballentine Carter, MD, Department of Urology, Marburg 403, Johns Hopkins School of Medicine, 600 N Wolfe St., Baltimore, MD 21287 (e-mail: hcarter{at}jhmi.edu).
Background: Prostate-specific antigen (PSA) level is typically used as a dichotomous test for prostate cancer, resulting in overdiagnosis for a substantial number of men. The rate at which serum PSA levels change (PSA velocity) may be an important indicator of the presence of life-threatening disease. Methods: PSA velocity was determined in 980 men (856 without prostate cancer, 104 with prostate cancer who were alive or died of another cause, and 20 who died of prostate cancer) who were participants in the Baltimore Longitudinal Study of Aging for up to 39 years. The relative risks (RRs) of prostate cancer death and prostate cancer–specific survival stratified by PSA velocity were evaluated in the three groups of men by Cox regression and Kaplan–Meier analyses. Statistical tests were two-sided. Results: PSA velocity measured 10–15 years before diagnosis (when most men had PSA levels below 4.0 ng/mL) was associated with cancer-specific survival 25 years later; survival was 92% (95% confidence interval [CI] = 84% to 96%) among men with PSA velocity of 0.35 ng/mL per year or less and 54% (95% CI = 15% to 82%) among men with PSA velocity above 0.35 ng/mL per year (P<.001). Furthermore, men with PSA velocity above 0.35 ng/mL per year had a higher relative risk of prostate cancer death than men with PSA velocity of 0.35 ng/mL per year or less (RR = 4.7, 95% CI = 1.3 to 16.5; P = .02); the rates per 100 000 person-years were 1240 for men with a PSA velocity above 0.35 ng/mL per year and 140 for men with a PSA velocity of 0.35 ng/mL per year or less. Conclusions: PSA velocity may help identify men with life-threatening prostate cancer during a period when their PSA levels are associated with the presence of curable disease.
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Correspondence about this Article
- Re: Detection of Life-Threatening Prostate Cancer With Prostate-Specific Antigen Velocity During a Window of Curability
- Ruth D. Etzioni, Donna P. Ankerst, and Ian M. Thompson
J Natl Cancer Inst 2007 99: 489-490.[Extract] [Full Text] [PDF]
Editorial about this Article
- Prostate-Specific Antigen and Prostate Cancer Prognosis
- Timothy R. Church
J Natl Cancer Inst 2006 98: 1509-1510.[Extract] [Full Text] [PDF]
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