PSA velocity needs to be lowered in younger men, data suggest

Young men with PSA velocities greater than 0.5 ng/mL/year are at significantly greater risk for prostate cancer, researchers reported here yesterday. This suggests that the traditional PSA velocity threshold of a 0.75 ng/mL/year to distinguish prostate cancer from benign conditions is too high and would miss a substantial proportion of prostate cancers among men younger than 60 years.

"The traditional PSA velocity is 0.75 ng/mL/year, but that PSA velocity is really based on older data - probably from PSA levels in men who are older (in their 60s and 70s) with higher median total PSA levels and who have larger prostates, where there is more background noise from BPH and other issues such as inflammation in the prostate, etc.," said study author Robert B. Nadler, MD, of the Feinberg School of Medicine, Northwestern University, Chicago.

Dr. Nadler and colleagues studied 6,844 men under the age of 60 years from 1989 to 2001 who were participating in a large prostate cancer screening study. Of those, 346 were subsequently diagnosed with prostate cancer.

They found that a PSA velocity of 0.4 ng/mL/year was the best value to help discriminate which young men have prostate cancer, while at the same time, performing the fewest amount of unnecessary biopsies. A multivariate analysis restricted to the subgroup of men with total PSA levels less than 2.5 ng/mL/year had similar results.