PSA velocity no help for predicting prostate cancer
Findings from Memorial Sloan-Kettering Cancer Center researchers find PSA velocity that is commonly used in conjunction with a standard PSA test is no help for predicting prostate cancer. The researchers suggest guidelines for prostate cancer risk based on how fast PSA rises should be removed from screening guidelines.
PSA velocity measurement leads to unnecessary anxiety and biopsies
PSA velocity determines how rapidly prostate specific antigen levels are rising, but can also lead to overdiagnosis, unnecessary biopsies, treatment and anxiety for men.
Researchers studied more than 5000 men who were part of the Prostate Cancer Prevention Trial. The men were over age 55, had baseline PSA levels of 3.0 (normal is
Yearly PSA tests, with biopsy was recommended for men with a PSA higher than 4.0 ng/mL. At the end of 7 years, men who did not have elevated PSA were asked to consent to biopsy. the study found that PSA was a better indicator of prostate cancer and found no evidence that high PSA velocity should used as a criteria for biopsy, unless there are other clinical findings.
Andrew Vickers, PhD, Associate Attending Research Methodologist in the Department of Epidemiology and Biostatistics who led the study said, “We have found no evidence to support the recommendation that men with a high PSA velocity should be biopsied in the absence of other indications. In other words, if a man’s PSA has risen rapidly in recent years, there is no cause for concern if his total PSA level is still low and his clinical exam is normal.”
The National Cancer Center Network and the American Urological Association recommend that men with a rapid rise in PSA, undergo surgical biopsy for prostate cancer, even when the prostate gland is not palpably enlarged and PSA levels are not above normal.
Peter T. Scardino, MD, Chair of the Department of Surgery, “This study should change practice. We have previously published papers determining that PSA naturally varies from month to month and have urged men whose PSA suddenly rises to wait six weeks and repeat the test before agreeing to a needle biopsy." He adds that "men should be cautious before rushing into a biopsy for minor variations in their PSA level.”
The study shows PSA velocity is not a good predictor of prostate cancer. Based on the findings, the researchers say it should not be a determinant for treatment.