PSA Velocity Decades Before Prostate Cancer Diagnosis AssociatedWith

PSA Velocity Decades Before Prostate Cancer Diagnosis Associated With
Decreased Survival

Article Date: 30 Dec 2006 - 15:00 PST

UroToday.com - A serum PSA increase of 2 ng/ml or greater the year
before prostate cancer diagnosis has recently been associated with a
higher risk of prostate cancer elated death. The association between
cancer-related death and PSA velocity decades before diagnosis (with
values significantly below 4.0 ng/ml) has not been well established.

Serum PSA velocity was calculated in a cohort of men followed for at
least 39 years in the Baltimore Longitudinal Study. PSA measurements and
rectal examination results were available for most patients since 1991.
PSA determinations before 1991 were performed on frozen sera collected
prospectively.

Of 980 men with serum PSA levels available, 20 had subsequently died of
prostate cancer, 104 were alive with prostate cancer or had died of
other causes, and 856 did not have a history of prostate cancer.

Interestingly, serum PSA velocity 10-15 years before diagnosis was
associated with prostate cancer survival 25 years later. Those patients
with a PSAv less than 0.35 ng/ml/year had a 25-year cancer-specific
survival of 92%, compared to 54% in patients with a PSAv > 0.35
ng/ml/year. Prostate cancer related death was significantly greater
(Hazard ratio 4.7, 95% CI 1.3 to 16.5) in patients with a PSAv greater
than 0.35 ng/ml/year, with a mortality rate of 1240 men per 100,000
person-years compared with 140 men per 100,000 person-years in patients
with a PSAv less than 0.35 ng/ml/year.

These data suggest that a PSA velocity greater than 0.35 ng/ml per year
decades before prostate cancer diagnosis may be associated with
subsequent prostate cancer death even when serum PSA levels are
considered “normal”.

H. Ballentine Carter, Luigi Ferrucci, Anna Kettermann, Patricia Landis,
E. James Wright, Jonathan I. Epstein, Bruce J. Trock, E. Jeffrey Metter
J Natl Cancer Inst 2006;98:1521 - 7.


knowledge is power - growing old is mandatory - growing wise is optional
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

> These data suggest that a PSA velocity greater than 0.35 ng/ml per year
> decades before prostate cancer diagnosis may be associated with
> subsequent prostate cancer death even when serum PSA levels are
> considered "normal".

I was under the impression that a yearly increase of .35 of PSA merits
further investigation. This paragraph is suggesting the "old" standard
(I assume .7) is still being applied and thus you could be waiting over
a decade before pc Dx. But if you're using .35 as your cutoff point you
could be diagnosing and treating it "decades" earlier.

Catalona has suggested this: (Note the second paragraph, this is esp a
powerful statement: Our data showed that a PSAV greater than 0.5 ng/ml
per year was more predictive of prostate cancer than age, total PSA
level, family history, or race.)

Study: From 1989 to 2001, 36,000 men participated in a prostate cancer
screen study. 6,844 were under 60 years old when the study began. 346
of these men were subsequently diagnosed with prostate cancer. In these
men, PSAV thresholds were examined for prediction of prostate cancer
risk.

Our data showed that a PSAV greater than 0.5 ng/ml per year was more
predictive of prostate cancer than age, total PSA level, family
history, or race. A study of a subgroup of these men whose PSA levels
were less than 2.5 had similar results.

Conclusion: The traditional PSAV threshold for biopsy of 0.75 ng/ml per
year is too high for men under age 60, and its use would result in
missing a substantial proportion of prostate cancers.

Young men with a PSAV greater than 0.5 ng/ml per year are at a
significantly greater risk for prostate cancer, and close follow-up is
warranted.

Essentially what this is saying to me is, "any man who is in his early
50's that is diagnosed with prostate cancer is in big trouble."

Most early detection is through the PSA test. Most biopsies are
probably triggered if it's over 4. So if you do the math and you are 41
and have a PSA of .05, the only way you can have a PSA over 4, which
triggers the test, is if your PSA rose more than .35 per year.

It makes sense. The faster growing cancers show up earlier.
How else can a man in his early 50's have his PSA grow to over 4? You
would think the cancer would have to be aggressive. A slower growing
cancer, therefore a less virulent one, would take more time to trigger
the magic number. Therefore most of them are detected in men in their
60's or 70's.

c palmer wrote:
> PSA Velocity Decades Before Prostate Cancer Diagnosis Associated With
> Decreased Survival
>
> Article Date: 30 Dec 2006 - 15:00 PST
>
> UroToday.com - A serum PSA increase of 2 ng/ml or greater the year
> before prostate cancer diagnosis has recently been associated with a
> higher risk of prostate cancer elated death. The association between
> cancer-related death and PSA velocity decades before diagnosis (with
> values significantly below 4.0 ng/ml) has not been well established.
>
> Serum PSA velocity was calculated in a cohort of men followed for at
> least 39 years in the Baltimore Longitudinal Study. PSA measurements and
> rectal examination results were available for most patients since 1991.
> PSA determinations before 1991 were performed on frozen sera collected
> prospectively.
>
> Of 980 men with serum PSA levels available, 20 had subsequently died of
> prostate cancer, 104 were alive with prostate cancer or had died of
> other causes, and 856 did not have a history of prostate cancer.
>
> Interestingly, serum PSA velocity 10-15 years before diagnosis was
> associated with prostate cancer survival 25 years later. Those patients
> with a PSAv less than 0.35 ng/ml/year had a 25-year cancer-specific
> survival of 92%, compared to 54% in patients with a PSAv > 0.35
> ng/ml/year. Prostate cancer related death was significantly greater
> (Hazard ratio 4.7, 95% CI 1.3 to 16.5) in patients with a PSAv greater
> than 0.35 ng/ml/year, with a mortality rate of 1240 men per 100,000
> person-years compared with 140 men per 100,000 person-years in patients
> with a PSAv less than 0.35 ng/ml/year.
>
> These data suggest that a PSA velocity greater than 0.35 ng/ml per year
> decades before prostate cancer diagnosis may be associated with
> subsequent prostate cancer death even when serum PSA levels are
> considered “normal”.
>
> H. Ballentine Carter, Luigi Ferrucci, Anna Kettermann, Patricia Landis,
> E. James Wright, Jonathan I. Epstein, Bruce J. Trock, E. Jeffrey Metter
> J Natl Cancer Inst 2006;98:1521 - 7.
>
>
> knowledge is power - growing old is mandatory - growing wise is optional
> "Many more men die with prostate cancer than of it. Growing old is
> invariably fatal. Prostate cancer is only sometimes so."
> http://community.webtv.net/PALMER_ENT/doc
>

jim west wrote:
> Essentially what this is saying to me is, "any man who is in his early
> 50's that is diagnosed with prostate cancer is in big trouble."
>
> Most early detection is through the PSA test. Most biopsies are
> probably triggered if it's over 4. So if you do the math and you are 41
> and have a PSA of .05, the only way you can have a PSA over 4, which
> triggers the test, is if your PSA rose more than .35 per year.
>
> It makes sense. The faster growing cancers show up earlier.
> How else can a man in his early 50's have his PSA grow to over 4? You
> would think the cancer would have to be aggressive. A slower growing
> cancer, therefore a less virulent one, would take more time to trigger
> the magic number. Therefore most of them are detected in men in their
> 60's or 70's.

There may be some truth to your argument, but it does contain one
possible logical flaw. You have to control for when the cancer started
developing. This can happen at different times of life for different
men. The more relevant information would be the time at which PSA
started to rise, and this wouldn't necessarily happen at the same age
for all men. The situation is further complicated by the fact that
other things except cancer can cause the PSA to start rising.
>
> c palmer wrote:
>> PSA Velocity Decades Before Prostate Cancer Diagnosis Associated With
>> Decreased Survival
>>
>> Article Date: 30 Dec 2006 - 15:00 PST
>>
>> UroToday.com - A serum PSA increase of 2 ng/ml or greater the year
>> before prostate cancer diagnosis has recently been associated with a
>> higher risk of prostate cancer elated death. The association between
>> cancer-related death and PSA velocity decades before diagnosis (with
>> values significantly below 4.0 ng/ml) has not been well established.
>>
>> Serum PSA velocity was calculated in a cohort of men followed for at
>> least 39 years in the Baltimore Longitudinal Study. PSA measurements and
>> rectal examination results were available for most patients since 1991.
>> PSA determinations before 1991 were performed on frozen sera collected
>> prospectively.
>>
>> Of 980 men with serum PSA levels available, 20 had subsequently died of
>> prostate cancer, 104 were alive with prostate cancer or had died of
>> other causes, and 856 did not have a history of prostate cancer.
>>
>> Interestingly, serum PSA velocity 10-15 years before diagnosis was
>> associated with prostate cancer survival 25 years later. Those patients
>> with a PSAv less than 0.35 ng/ml/year had a 25-year cancer-specific
>> survival of 92%, compared to 54% in patients with a PSAv > 0.35
>> ng/ml/year. Prostate cancer related death was significantly greater
>> (Hazard ratio 4.7, 95% CI 1.3 to 16.5) in patients with a PSAv greater
>> than 0.35 ng/ml/year, with a mortality rate of 1240 men per 100,000
>> person-years compared with 140 men per 100,000 person-years in patients
>> with a PSAv less than 0.35 ng/ml/year.
>>
>> These data suggest that a PSA velocity greater than 0.35 ng/ml per year
>> decades before prostate cancer diagnosis may be associated with
>> subsequent prostate cancer death even when serum PSA levels are
>> considered “normal”.
>>
>> H. Ballentine Carter, Luigi Ferrucci, Anna Kettermann, Patricia Landis,
>> E. James Wright, Jonathan I. Epstein, Bruce J. Trock, E. Jeffrey Metter
>> J Natl Cancer Inst 2006;98:1521 - 7.
>>
>>
>> knowledge is power - growing old is mandatory - growing wise is
>> optional "Many more men die with prostate cancer than of it.
>> Growing old is
>> invariably fatal. Prostate cancer is only sometimes so."
>> http://community.webtv.net/PALMER_ENT/doc
>>
>

In my scenario it doesn't matter when the cancer started to rise if you
are in your early 50's. In fact, if it started to rise when you are in
your late forties that means the increase was much greater than .35 per
year or otherwise how would you cross the threshold for being biopsied?

It's unnerving if you are a "younger" patient diagnosed with it. If you
are 52 and your PSA is 4.5 and it was at 1 at 43, your average rise is
over .35. That seems like a small increase per year.

Leonard Evens wrote:
> jim west wrote:
>
>> Essentially what this is saying to me is, "any man who is in his early
>> 50's that is diagnosed with prostate cancer is in big trouble."
>>
>> Most early detection is through the PSA test. Most biopsies are
>> probably triggered if it's over 4. So if you do the math and you are
>> 41 and have a PSA of .05, the only way you can have a PSA over 4,
>> which triggers the test, is if your PSA rose more than .35 per year.
>>
>> It makes sense. The faster growing cancers show up earlier.
>> How else can a man in his early 50's have his PSA grow to over 4? You
>> would think the cancer would have to be aggressive. A slower growing
>> cancer, therefore a less virulent one, would take more time to trigger
>> the magic number. Therefore most of them are detected in men in their
>> 60's or 70's.
>
>
> There may be some truth to your argument, but it does contain one
> possible logical flaw. You have to control for when the cancer started
> developing. This can happen at different times of life for different
> men. The more relevant information would be the time at which PSA
> started to rise, and this wouldn't necessarily happen at the same age
> for all men. The situation is further complicated by the fact that
> other things except cancer can cause the PSA to start rising.
>
>>
>> c palmer wrote:
>>
>>> PSA Velocity Decades Before Prostate Cancer Diagnosis Associated With
>>> Decreased Survival
>>>
>>> Article Date: 30 Dec 2006 - 15:00 PST
>>>
>>> UroToday.com - A serum PSA increase of 2 ng/ml or greater the year
>>> before prostate cancer diagnosis has recently been associated with a
>>> higher risk of prostate cancer elated death. The association between
>>> cancer-related death and PSA velocity decades before diagnosis (with
>>> values significantly below 4.0 ng/ml) has not been well established.
>>>
>>> Serum PSA velocity was calculated in a cohort of men followed for at
>>> least 39 years in the Baltimore Longitudinal Study. PSA measurements and
>>> rectal examination results were available for most patients since 1991.
>>> PSA determinations before 1991 were performed on frozen sera collected
>>> prospectively.
>>>
>>> Of 980 men with serum PSA levels available, 20 had subsequently died of
>>> prostate cancer, 104 were alive with prostate cancer or had died of
>>> other causes, and 856 did not have a history of prostate cancer.
>>>
>>> Interestingly, serum PSA velocity 10-15 years before diagnosis was
>>> associated with prostate cancer survival 25 years later. Those patients
>>> with a PSAv less than 0.35 ng/ml/year had a 25-year cancer-specific
>>> survival of 92%, compared to 54% in patients with a PSAv > 0.35
>>> ng/ml/year. Prostate cancer related death was significantly greater
>>> (Hazard ratio 4.7, 95% CI 1.3 to 16.5) in patients with a PSAv greater
>>> than 0.35 ng/ml/year, with a mortality rate of 1240 men per 100,000
>>> person-years compared with 140 men per 100,000 person-years in patients
>>> with a PSAv less than 0.35 ng/ml/year.
>>>
>>> These data suggest that a PSA velocity greater than 0.35 ng/ml per year
>>> decades before prostate cancer diagnosis may be associated with
>>> subsequent prostate cancer death even when serum PSA levels are
>>> considered “normal”.
>>>
>>> H. Ballentine Carter, Luigi Ferrucci, Anna Kettermann, Patricia Landis,
>>> E. James Wright, Jonathan I. Epstein, Bruce J. Trock, E. Jeffrey Metter
>>> J Natl Cancer Inst 2006;98:1521 - 7.
>>>
>>>
>>> knowledge is power - growing old is mandatory - growing wise is
>>> optional "Many more men die with prostate cancer than of it.
>>> Growing old is
>>> invariably fatal. Prostate cancer is only sometimes so."
>>> http://community.webtv.net/PALMER_ENT/doc
>>>
>>