Rise in PSA Level May Predict Cancer Death
Aggressive Prostate Cancer Treatment Advised Instead of Watchful Waiting
July 7, 2004 -- There's a new red flag for men facing prostate cancer surgery: It's called PSA velocity. When PSA (prostate specific antigen) level increases sharply in the months before surgery, the cancer is likely to be aggressive.
Men with localized prostate cancer whose PSA increases sharply have a higher risk of dying from their cancer -- whether they have surgery or not, researchers say. Their study appears in this week's issue of TheNew England Journal of Medicine. These men should be treated aggressively and given priority for clinical trials to improve their survival chances.
In his study, lead researcher Anthony V. D'Amico, MD, PhD, with Brigham and Women's Hospital and Dana-Farber Cancer Institute, investigates PSA velocity as an indicator of advanced tumors. The rate at which PSA levels rise -- called PSA velocity -- prior to surgery seems to predict the death from prostate cancer.
Men with high PSA velocity in the months before diagnosis were nearly 10 times more likely to die from prostate cancer within the next five to seven years, he reports.
It brings up the issue of "watchful waiting," which has been debated among prostate cancer specialists. Today, prostate cancer is typically detected via PSA tests long before a tumor is evident.
Prostate cancer often grows so slowly that men will frequently die of other causes, so doctors will monitor the cancer but patents won't receive active treatment as long as symptoms do not occur or worsen.
"Watchful waiting is an option for managing localized prostate cancer when both the patient and physician agree that the potential adverse effects of treatment exceed the expected benefits," writes D'Amico.
But the rapidly growing body of information on PSA suggests that PSA velocity "will become critical in predicting prostate cancer survival," writes Mario Eisenberger, MD, with Johns Hopkins Medical Institutions, in an accompanying editorial.
The 1,095 men in D'Amico's study all had localized prostate cancer -- it had not spread beyond the prostate. During the year before diagnosis, each had their PSA levels tested. Following diagnosis of prostate cancer, each had radical prostate cancer surgery. Researchers kept track of the men's progress for the next seven years.
Overall, there were 366 cancer recurrences and 84 deaths; 27 deaths were from prostate cancer.
For men whose PSA velocity was 2.0 nanograms per milliliter per year or higher, the risk of death from prostate cancer was nearly 10 times higher compared with men whose PSA level increased more slowly.
The increased risk of death from prostate cancer in men with high PSA velocities occurred despite the fact that these men underwent surgery.
Bottom line: Watchful waiting may be advised only for healthy men with low PSA velocity.
D'Amico is recruiting men with high PSA velocity for a study comparing results of prostate cancer surgery with an aggressive radiation-chemotherapy treatment.