Change in PSA level may not predict prostate cancer

Center statistical analyses show screening for PSA velocity can lead to unnecessary biopsies
Cathee Till
Cathee Till conducted statistical analyses on Prostate Cancer Prevention Trial data that showed change in PSA levels over time, in the absence of other indications, is a poor predictor of prostate cancer. Photo by Linsey Battan

New research has shown that change in PSA levels over time—known as PSA velocity—is a poor predictor of prostate cancer and may lead to many unnecessary biopsies. The study findings were published online Feb. 24 in the Journal of the National Cancer Institute.

“We have found no evidence to support the recommendation that men with a high PSA velocity should be biopsied in the absence of other indications,” said lead author Dr. Andrew Vickers of Memorial Sloan-Kettering Cancer Center. “If a man's PSA has risen rapidly in recent years, there is no cause for concern if his total PSA level is still low and his clinical exam is normal.”

Cathee Till of the Public Health Sciences Division conducted statistical analyses. The study's population of 5,519 men ages 55 and older came from the Prostate Cancer Prevention Trial, a randomized, controlled clinical trial designed to assess the ability of the baldness drug finasteride to prevent prostate cancer. The Center played an integral role in the decade-long study of nearly 19,000 men. The Southwest Oncology Group, whose statistical center is housed in PHS, coordinated the PCPT.

In the current study, the authors found no important association between PSA velocity and biopsy outcome after adjusting for risk factors such as age, race, and PSA levels. PSA alone was a much better predictor of biopsy outcome than PSA velocity.

Prostate cancer is the most common cancer among American men and the second leading cause of cancer deaths in men, according to the American Cancer Society. While PSA screening is widely used for the early detection of prostate cancer, it is also associated with a high rate of overdiagnosis, which can lead to unnecessary treatment and anxiety.

Currently early detection guidelines of several organizations recommend that men with a high PSA velocity have a surgical biopsy for prostate cancer, even if there are no other indicators that cancer may exist.

The Prostate Cancer Foundation, the Sidney Kimmel Center for Prostate and Urologic Cancers, the National Cancer Institute and the National Institutes of Health, funded the work.

[Adapted from a Memorial Sloan-Kettering Cancer Center news release]

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