Can Prostate Specific Antigen Velocity Thresholds Decrease Insignificant Prostate Cancer Detection?

Abstract

A controversy of current PSA-based prostate cancer screening is the overdetection of potentially insignificant prostate cancer. Because PSA kinetics have previously been linked to prostate cancer-specific mortality, our objective was to determine whether PSA velocity (PSAV) was associated with clinically significant prostate cancer. From 1992 to 2008, 1073 men underwent radical prostatectomy with data on PSA velocity and tumor volume. “Insignificant” cancer was defined by the Ohori criteria (organ-confined, tumor volume ≤0.5 cc, no primary or secondary Gleason pattern 4 or 5). We calculated the proportion of men with pathologically “insignificant” prostate cancer, stratified by PSAV. A preoperative PSAV >0.4 ng/ml was significantly associated with high-grade disease (p=0.008), positive surgical margins (p=0.003), and seminal vesicle invasion (p=0.007) at radical prostatectomy. The median tumor volume was also significantly higher among men with a preoperative PSAV >0.4 ng/ml/year (3.1 vs. 2.4 cc, p=0.0001). Overall, 69 (6%) met the Ohori criteria for “insignificant” cancer. Patients with a preoperative PSAV >0.4 ng/ml/year were 50% less likely to have “insignificant” disease (10% vs. 5%, respectively, p=0.003). A PSAV threshold of 0.4 ng/ml/year distinguished between men who did or did not meet published pathology criteria for potentially “insignificant” prostate cancer. These results suggest that PSAV may be a useful adjunct in prostate cancer screening to increase the specificity for identifying patients with clinically significant disease.