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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2007PSA Velocity in Men With Total PSA Less Than 4 ng/ml
Article by Dr. Catalona suggesting a different PSA velocity cutpoint for untreated men with a PSA in the 4-10 range vs. men with a PSA less than 4 ng/ml...ron -------------------------------------------------------------------------------------------------------------------------------------- J Urol. 2007 Oct 12; Vol. 178, Issue 6, pp 2348-53 Prostate Specific Antigen Velocity in Men With Total Prostate Specific Antigen Less Than 4 ng/ml. Loeb S, Roehl KA, Nadler RB, Yu X, Catalona WJ. Department of Urology, the James Buchanan Brady Urological Institute, the Johns Hopkins Medical Institutions, Baltimore, Maryland (SL). PURPOSE: A prostate specific antigen velocity threshold of 0.75 ng/ml per year has commonly been used to distinguish men with prostate cancer from those with benign prostate conditions. In addition, a prostate specific antigen velocity greater than 2 ng/ml per year has been linked to an increased prostate cancer specific mortality rate after radical prostatectomy and after radiation therapy. However, both of these frequently cited thresholds were determined largely in groups of men with a prostate specific antigen greater than 4 ng/ml. MATERIALS AND METHODS: Of approximately 26,000 men who participated in a prostate cancer screening study 22,019 had a prostate specific antigen of 4 ng/ml or less. Of these men 501 were diagnosed with prostate cancer and had sufficient data for a prostate specific antigen velocity calculation. We performed univariate and multivariate analyses to compare cancer detection rates and performance characteristics using various prostate specific antigen velocity thresholds in these men. RESULTS: In men with a prostate specific antigen less than 4 ng/ml, a prostate specific antigen velocity threshold of 0.4 ng/ml per year was most useful for recommending prostate biopsy. Overall prostate cancer was diagnosed in 223 (2%) men with a prostate specific antigen velocity less than 0.4 ng/ml per year compared to 278 (13%) men with a prostate specific antigen velocity greater than 0.4 ng/ml per year (p <0.0001). On multivariate analysis a prostate specific antigen velocity greater than 0.4 ng/ml per year was a stronger independent predictor of prostate cancer diagnosis than age, race or a family history of prostate cancer. CONCLUSIONS: The traditional prostate specific antigen threshold of 0.75 ng/ml per year was determined largely in men with a total prostate specific antigen of 4 to 10 ng/ml. Prostate specific antigen velocity thresholds in the range of 0.4 ng/ml per year should be used to help guide the need for biopsy in men with a total prostate specific antigen less than 4 ng/ml. PMID: 17936844 > Article by Dr. Catalona suggesting a different PSA velocity cutpoint > for untreated men with a PSA in the 4-10 range vs. men with a PSA less [quoted text clipped - 45 lines] > > PMID: 17936844 That is very interesting. Had we used this criterion, I probably would have been diagnosed a year earlier. My Gleason score might have been 6=3+3 instead of 7=3+4. As it turned out my post surgical pathology looked very good, and my chances of recurrence are quite low. So perhaps it didn't really matter in the end. > Article by Dr. Catalona suggesting a different PSA velocity cutpoint > Overall prostate cancer > was diagnosed in 223 (2%) men with a prostate specific antigen > velocity less than 0.4 ng/ml per year compared to 278 (13%) men with a > prostate specific antigen velocity greater than 0.4 ng/ml per year (p > <0.0001). > CONCLUSIONS: Prostate specific antigen > velocity thresholds in the range of 0.4 ng/ml per year should be used > to help guide the need for biopsy in men with a total prostate > specific antigen less than 4 ng/ml. Tried ot look at the full text, but you need to pay. I'd certainly want to look at the data before I accepted his new .4 cutoff. Under .4 was 2% while .4 and over was 13% 2% to 13%.....thats a huge difference. I'd like to see the gradation between 2 and 13 percent and whats included in the over .4 group. What are the .5, .6, and .75 percentages that weight the .4 cutoff? This is a continuum. Whats the difference between the group from .35 to .40 and the group from .40 to .45. Or is it just too late and I'm not thinking straight? BTW, am I the only one thinking 13% is not all that high? Using Dr. Catalona's two criteria, .4 acceleration along with his 2.5 psa threshold, it looks like we'll be tripling the number of biopsies and probably doubling the numbers of prostate cancers found. If, as many suggest, we are over treating now, then what will be happening with the new standards set at .4 and 2.5 ? Perhaps someone will post the data I am asking about. >> Article by Dr. Catalona suggesting a different PSA velocity cutpoint > [quoted text clipped - 28 lines] > >Perhaps someone will post the data I am asking about. I don't have the data but it must be, as you say above, a continuum. We're constantly being shoved into 2 or perhaps 3 categories, mild medium and/or strong and it becomes impossible to make any sense of the results for those who sit on the breakpoints; it's quite improbable that the prospects for a particular 0.39/yr are going to be markedly different from those of a 0.41. I note 0.4 in 4, (10%) would equate to an approx 7 year doubling time assuming a geometric rise. 7 years or above still looks like a comfort zone to me. And yes, I think you're right, 13% is not all that high. As things stand, if I were not too young, PSA</=4 with an estimated doubling >/=7 years, I would probably sit tight and forego the biopsy for a couple of years to get a little more precision on the velocity curve. I don't advocate it, but I think it's what I would do. hello ron....it is great to know that you continue to contribute, to the group, great information.....i had proton (only) at loma linda and continue to do well since my treatment ended in may 03.....if there are any positive or negative issues after my 5yr anniversary, i will certainly share it with the group...... > hello ron....it is great to know that you continue to contribute, to the > group, great information.....i had proton (only) at loma linda and > continue to do well since my treatment ended in may 03.....if there are > any positive or negative issues after my 5yr anniversary, i will certainly > share it with the group...... Hi Keith...Glad to hear that things are going so well. Five years is a milestone, good luck on the check up!..Best wishes and good health, ron > Article by Dr. Catalona suggesting a different PSA velocity cutpoint > for untreated men with a PSA in the 4-10 range vs. men with a PSA less > than 4 ng/ml...ron If my primary doc had known this advice back when my psa was 3.26 and sounded the alarm, I may have found out then that my maternal grandfather had pCa. I would have then closely monitored my velocity or had a biopsy then instead of going to a different primary doctor for insurance reasons, that diddn't even proscribe a psa test for me when I was 49. I partly take the blame for that oversight by not coordinating my prior records to the new primary doc. It wasn't until the next primary doctor red flagged the 4.2 psa I showed when I was 52 had a positive biopsy and I found out then that my maternal grandfather had pCA and ...well the rest is historic enough for me to be here posting. On a separate note, I always am conflicted to announce the good news that I passed another post op 3 month psa test resulting in another <0.1 knowing there are many here that do not get this good news. I've now thrown 7 aces in a row. But I feel it helps many in similar circumstances to maintain a positive attitude. I've been off of 9 months of HT (hormone therapy) for 10 months now, can say I feel as good as I did post HT, the body hair has returned, am no longer a second slow with awareness on the B'ball court, T has returned to normal levels. I will also add that I convinced my onc to have me take the tests to baseline the assays for the other biomarkers other than psa because of my Gleason 8. Thanks to Steve Jordan or was it Steve Kramer, for that bit of knowledge. Regardless of the Steve, you've both been a wonderful source of information and support. Thanks, WhiteSoxFan > On a separate note, I always am conflicted to > announce the good news that I passed another post op 3 month psa test > resulting in another <0.1 knowing there are many here that do not get > this good news. I've now thrown 7 aces in a row. But I feel it helps > many in similar circumstances to maintain a positive attitude. No need to be conflicted. I don't think there is a man (or SO) here that does not like to see when one of us has good news. It's a support group, not a contest. We share in all the cicumstances; agony and ecxtacy. > I will also add that I convinced my onc to > have me take the tests to baseline the assays for the other biomarkers > other than psa because of my Gleason 8. Thanks to Steve Jordan or was > it Steve Kramer, for that bit of knowledge. That would be Jordan. I wonderful asset to this forum. |
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