Among the 660 men who chose radical prostatectomy -- surgical removal of the prostate -- there were 89 deaths within a median 5.4 years. Prostate cancer caused 29 of these deaths. In 44% of these prostate-cancer deaths, the only sign of high-risk disease was a PSA rise of at least 2 ng/mL in the year before treatment.
Among the 288 men who chose external-beam radiation treatment, there were 75 deaths within a median four years. Prostate cancer caused 32 of these deaths. In 28% of these prostate cancer deaths, the only sign of high-risk disease was a PSA rise of at least 2 ng/mL in the year before treatment.
Other clues that a man is at increased risk of dying from prostate cancer are tumors with a score of 7 or more on the Gleason tumor aggressiveness score; clinical disease that has advanced to the T2b stage; and a PSA level of greater than 10 ng/mL.
But none of these signs was as powerful as what D'Amico and colleagues call "PSA velocity."
When men had just one sign of severe cancer, that sign was PSA velocity for 88% of patients treated with surgery and in 80% of patients treated with external-beam radiation therapy.
D'Amico and colleagues advise men who have this kind of rapid PSA rise to enroll in clinical trials testing more intensive prostate cancer treatment.
There's some evidence that taking testosterone-blocking drugs in addition to surgery or radiation can improve prostate cancer survival in these men. There's also evidence that adding chemotherapy to surgery or radiation can prolong prostate cancer survival.
The findings appear in the July 1 issue of the American Cancer Society journal Cancer.