Study shows benefits of PSA velocity risk count testing for PCa

Tracking PSA levels over time offers a more accurate assessment of the risk of life-threatening prostate cancer, and novel PSA velocity risk count testing associated with fluctuations in PSA levels may provide a more effective way to screen for clinically significant prostate cancer, a recent multicenter study concludes.

Based on findings that there is an increased risk of aggressive prostate cancer if PSA goes up by more than by 0.4 ng/mL in consecutive years, the authors assigned a risk count of "2" for multiple increases of more than 0.4 units, a "1" if there was only one increase by more than 0.4 units, and a "0" risk count if there was no increase by more than 0.4 units.

After evaluating 18,214 men undergoing prostate cancer screening, of whom 1,125 were diagnosed with the disease, results showed a risk count of "2" was associated with a greater than eight-times risk of prostate cancer and a fivefold greater risk of aggressive disease.

The authors, led by Stacy Loeb, MD, of New York University Langone Medical Center, New York, conclude that risk count screening may be useful in diagnosing aggressive prostate cancer earlier while possibly reducing unnecessary biopsy, as well as the overdiagnosis and resulting overtreatment of low-risk prostate cancer.

"A persistently rising PSA is a harbinger for life-threatening prostate cancer," said senior author William Catalona, MD, of Northwestern University Feinberg School of Medicine, Chicago. "Our study findings show looking at how much PSA changes over time helps distinguish which cancers are aggressive more so than a single PSA value."

The study, which was published in BJU International (2012; 109:508-13), increases contention surrounding PSA testing in general, and specifically PSA velocity testing.

A second study, published online in the same journal (Feb. 7, 2012), sought to determine whether PSA velocity, PSA doubling time, or PSA percentage change could add incremental information to PSA alone for community-based men undergoing prostate cancer screening. It concluded that PSA is a better predictor of future prostate cancer than PSA velocity, doubling time, or percentage change and that adding the three measurements to PSA does not result in clinically relevant improvements in the ability to predict future prostate cancer.

An earlier study published in the Journal of the National Cancer Institute counters current guidelines from the National Comprehensive Cancer Network and the AUA on early prostate cancer detection that recommend biopsy on the basis of high PSA velocity, even in the absence of other indications such as an elevated PSA or a positive digital rectal exam. The study found no evidence to support a recommendation that high PSA velocity should result in biopsy in the absence of other indications.

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