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World J Urol. 2011 Feb;29(1):11-4. doi: 10.1007/s00345-010-0625-4. Epub 2010 Dec 14.

Significance of preoperative PSA velocity in men with low serum PSA and normal DRE.

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1
Department of Urology and The Section on Value and Comparative Effectiveness, New York University School of Medicine, New York, NY, USA.

Abstract

OBJECTIVES:

A PSA velocity (PSAV)>0.35 ng/ml/year approximately 10-15 years prior to diagnosis is associated with a greater risk of lethal prostate cancer. Some have recommended that a PSAV>0.35 ng/ml/year should prompt a prostate biopsy in men with a low serum PSA (<4 ng/ml) and benign DRE. However, less is known about the utility of this PSAV cutpoint for the prediction of treatment outcomes among men undergoing radical prostatectomy (RP).

METHODS:

Between 1992 and 2007, 339 men underwent RP at our institution with a preoperative PSA<4 ng/ml, benign DRE, and multiple preoperative PSA measurements. PSAV was calculated by linear regression analysis using all PSA values within 18 months prior to diagnosis. Kaplan-Meier survival analysis was performed, and biochemical progression rates were compared between PSAV strata using the log-rank test.

RESULTS:

The preoperative PSAV was >0.35 ng/ml/year in 124 (36.6%) of 339 men. Although there were no significant differences in clinico-pathological characteristics based upon PSAV, men with a PSAV>0.35 ng/ml/year were significantly more likely to experience biochemical progression after RP at a median follow-up of 4 years (P=0.022).

CONCLUSIONS:

In this low-risk population with a preoperative PSA<4 ng/ml and benign DRE, approximately 1/3 had a preoperative PSAV>0.35 ng/ml/year. Physicians should carefully monitor men with a preoperative PSA>0.35 ng/ml/year as they are at increased risk of biochemical progression following RP.

PMID:
21153643
PMCID:
PMC3034139
DOI:
10.1007/s00345-010-0625-4
[Indexed for MEDLINE]
Free PMC Article
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