PSA Velocity: Helpful for All Men Over Age 40
(This article is prepared for Quest readers by Cecilia Lacks, PhD from a *journal article on the topic by Stacy Loeb, MD; Kimberly A. Roehl; William J. Catalona, MD; and Robert B. Nadler, MD)
PSA Velocity (PSAV), the change in PSA per year, has become an important tool in early detection of prostate cancer and in distinguishing prostate cancer from benign conditions.
In addition, recent studies show a link between PSAV and prostate cancer aggressiveness.
Because both an enlarged prostate (BPH) and infection of the prostate (prostatitis) can cause higher PSA levels and because both conditions are more prevalent in older men, the theory was that PSA velocity might only be a useful diagnostic tool for men under 60.
The authors’ study (Catalona) showed differently. It found that the same PSAV thresholds for biopsy recommendation could reasonably be applied to all men over 40 years old.
Also, the study showed that regardless of the age group, for purposes of diagnosis, both PSA and PSAV were significant independent predictors of prostate cancer.
In the past, a PSAV of .75 (i.e. a rise in PSA of 0.75 ng/mL in a year) was used to guide a biopsy recommendation. Previous studies (Catalona) reported on the use of PSAV exclusively in men under 60 years old and found that a threshold of 0.4 ng/mL/year performed better than the traditional 0.75 ng/mL/year.
This present study showed the same was true for contemporary men over 60, the majority of whom also have PSA levels less than 4 ng/ml in the absence of prostate disease. (Dr. Catalona recommends biopsy at the same PSA threshold of 2.5 ng/mL for men of all ages.)
The 2007 National Comprehensive Cancer Network Guidelines recommended that PSA screening be offered beginning at age 40 years and that the subsequent frequency of screening should be based upon the relationship between the PSA level and the age-specific median.
Moreover, they recommended that a prostate biopsy be considered for men with PSA levels more than 2.5 whose PSAV is more than 0.35 ng/mL/year.
An enlarged prostate, more common in older men, does not interfere with this recommendation. A natural PSA velocity goes along with BPH but the actual rate of rise is much less than 0.35 ng/mL/year.
Other studies (Eggener) have reported that very high and sudden spikes (greater than 3 ng/mL/year) are related frequently to prostatitis.
Once prostatitis has been ruled out in these instances, the basic conclusion is that men without cancer don’t have rapid rises in PSA at any age group. Then, the rising PSA is suggestive of cancer.
*Is the utility of prostate-specific antigen velocity for prostate cancer detection affected by age? ©authors 2008 from Journal Compilation,BJU International