PSA velocity for assessing prostate cancer risk in men with PSA levels between 2.0 and 4.0 ng/ml

Objectives. To evaluate the use of prostate-specific antigen (PSA) velocity (PSAV) in assessing prostate cancer risk among men with PSA levels less than 4.0 ng/mL. Methods. The relative risk of, and cumulative probability of freedom from, prostate cancer by PSAV was evaluated in 89 male participants (21 with cancer and 68 controls) of a longitudinal aging study—the Baltimore Longitudinal Study of Aging (National Institute on Aging)—who had serial PSA levels between 2.0 and 4.0 ng/mL for at least 18 months. The relative risk was estimated from a Cox proportional hazards regression model, and the disease-free probability was determined by Kaplan-Meier survival analysis. The sensitivity and specificity of PSAV were calculated as a measure of test validity. Results. The sensitivity and specificity of a PSAV of 0.1 ng/mL per year was 81% and 50%, respectively. The relative risk of prostate cancer was 6.53 (range 1.90 to 22.51) when the PSAV was 0.1 ng/mL per year or more compared with a PSAV of less than 0.1 ng/mL per year ( P = 0.0029). At 10 years, the cumulative probability of freedom from prostate cancer was 97.1% (range 91.4% to 100%) and 35.2% (range 14.0% to 56.4%) when the PSAV was less than and greater than 0.1 ng/mL per year, respectively. Survival curves began to differ at less than 5 years after the baseline PSAV determination. Conclusions. The association between PSAV and the subsequent risk of prostate cancer suggests that the PSAV may be useful in the risk assessment of men with lower PSA levels.