Johns Hopkins Health Alert
Using PSA Velocity to Predict Prostate Cancer Risk
Johns Hopkins researchers have found that PSA velocity can predict prostate cancer many years in advance when it is more curable.PSA velocity is a measurement of how quickly a man's prostate-specific antigen (PSA) level rises from one year to the next. A rapid rise in PSA (a high PSA velocity) suggests the presence of prostate cancer. A study from Johns Hopkins and the National Institute on Aging found that an increase in PSA level of more than 0.75 ng/mL per year was an early predictor of prostate cancer in men with PSA levels between 4 ng/mL and 10 ng/mL.
PSA velocity is especially helpful in detecting early cancer in men with mildly elevated PSA levels and a normal digital rectal exam. It is most useful in predicting the presence of cancer when changes in PSA are evaluated over at least one to two years. In a study reported in The New England Journal of Medicine, a rapid rise in PSA level (more than 2 ng/mL) in the year before prostate cancer diagnosis and surgical treatment predicted a higher likelihood that a man would die of his cancer over the next seven years.
Now a study by Johns Hopkins researchers shows that PSA velocity can predict which men will develop life-threatening prostate cancer many years later. The study subjects were 980 men who had been long-time participants in the Baltimore Longitudinal Study of Aging, sponsored by the National Institute on Aging.
The researchers found that PSA velocity measured 10–15 years before prostate cancer diagnosis predicted their cancer-related survival 25 years later. Ninety-two percent of the men whose PSA velocity was 0.35 ng/mL or less per year had survived, compared with 54% of those whose PSA velocity was greater than 0.35 ng/mL per year. About five times more men in the higher PSA–velocity category died of prostate cancer than in the lower-velocity category. When PSA velocity was being measured, most of the men’s PSA levels were below 4.0 ng/mL, the traditional cutoff point for lower risk. These results suggest that PSA velocity may help identify high-risk men early, when their disease is more curable. This data was reported in the Journal Of The National Cancer Institute (Volume 98, page 1521).
Posted in Prostate Disorders on August 30, 2007
Reviewed September 2011
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I wish the medical community would stop calling the current options available to prostate cancer sufferers a "cure". What is offered today by western medicine are ways of ridding a man of prostate cancer by removing or destroying his prostate, and, thereby, fundamentally changing his sex life, and very possibly leaving him incontinent. As a young (51) man with a positive biopsy, I'm not exactly ready to give up my virility, and I would hardly call a choice between mutilation or death, a "cure".
Posted by: zbearx | September 1, 2007 9:04 AM
Although not a "cure", if Prostate Cancer is detected in early stage, and if certain qualifications are met, pro-actively following the Johns Hopkins' "Expectant Management with Curative Intent" program, led by Dr. H. Ballentine Carter, may preclude the need for surgical removal of the prostate, or alternate options.
Posted by: berg07417 | September 1, 2007 2:37 PM
Glad to read your Alerts.....I am new to this site and this is my first question. I am 59 years old and just received the results of my annual physical exam. The test showed a PSA level of 5.13. Report showed that the test was repeated from same sample. Is this a major concern since I had sex the night before the test? (Not knowing that I shouldn't). My doctor recommended that I see a Urologist but thought to call him and ask to repeat the test on a new sample keeping in mind to not have sex for the recommended 72 hours this time. Do recommend to see a Urologist or repeat the test? Here is the history of my PSA tests over the last few years:
Year PSA velocity
2000 2.4
2002 2.6 0.2
2003 2.4 -0.2
2005 2.6 0.2
2007 3.8 1.2
2008 5.13 1.33 Verified by repeat test from same sample
What do you think?
Posted by: PSA5 | September 16, 2008 9:48 PM
I find your alerts very thought provoking and at the same time, reassuring. I realise I am not alone, and the thoughts and emotions I have are shared by others.
I was fortunate to be diagnosed with Prostate Cancer (by biopsy) about 15 months ago - when it was at an early stage. (Gleeson 6 (3+3) / T1C) For the record I had a PSA of 1.5. and was on a research project to find better ways of early detection and treatment of Prostate Cancer.
In the UK, PSA monitoring is NOT a regular event, therefore it is impossible to check the PSA Velocity over 10 to 15 years.
I endorse the comments of Silversmoke - though I have to say it is a fine balance between active monitoring and proactive treatment.
I have changed my attitude towards treatment following consultations with a couple of oncologists - each with very different attiudes.
My Treament Plan is now based on Active Monitoring backed up by Brachytherapy (against the original plan of urgent surgury).
As one of the oncologists explained to me - when the side-effects of the treatment (not cure) are worse than the symptoms, why go through the pain (of the treatment and side effects), and anyway, over time more appropriate treatments may arise with less intrusive side effects that may revise the decisions.
Posted by: Ramwob | April 30, 2009 6:31 AM
It seems clear the PSA velocity has more significance than the PSA value itself. One risk I noted was when a 3.1 PSA(2007) moved to 8.1(2008) which resulted in a referral to a urologist. He wanted to schedule an immediate biopsy and scan. I decided to think about it for a while and two months later called our family doctor and repeated the PSA - 3.8. Without a judgment on the DRE before the blood test, a reasonable person might suggest a confirming test with an increase like that. The repeat test was relatively inexpensive and quick and avoided a risky and unpleasant test that very likely would not have shown anything. I waited 2 months for arbitrary reasons. My family doctor speculated about prostitus but I also had a urinalysis.
Posted by: R49 | April 30, 2009 7:18 AM
For xbearx: I had a radical prostatectomy 3 months ago, and while I'm still getting back to normal, I can "see normal" from here in terms of both continence and sexual function. Mutilation is way too strong a term for surgery that can work well, work poorly, or somewhere in between, and which does have a decent probability of extending your life. Within a few weeks of being diagnosed with early prostate cancer, I met three different people who lost immediate relatives to prostate cancer...and none of them had good last years. Made it easy for me to decide. It's your call how you deal with it, but don't assume that life stops after a prostatectomy...it doesn't necessarily!
Posted by: cmiller | May 3, 2009 12:22 AM
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PSA is not an absolute test, I have prostate cancer and my PSA is .75, should have a DRE yearly is over age of 50
Posted by: silversmoke | September 1, 2007 7:16 AM