Abstract
Studies looking at prostate-specific antigen (PSA) kinetics have emerged in the last two decades with the intent to better discern which PSAs are actually associated with prostate cancer and, more importantly, aggressive disease. Carter et al from Johns Hopkins were the first to assess PSA velocity (PSAV) as a potential risk factor for development of prostate cancer using the Baltimore Longitudinal Study of Aging (BLSA). 1 Carter H.B. Pearson J.D. Metter E.J. et al. Longitudinal evaluation of prostate specific antigen levels in men with and without prostate disease. JAMA. 1992; 267: 2215-2220 Crossref PubMed Scopus (929) Google Scholar The authors looked at the serum levels of PSA taken 7-25 years before the development of “prostate disease” (benign prostatic hyperplasia [BPH] or prostate cancer) and concluded that a rate of change of 0.75 μg/L/y was significantly greater in subjects with prostate cancer compared with control subjects and subjects with BPH, and therefore “may be a sensitive and specific early clinical marker for the development of prostate cancer.” Distribution of PSA Velocity by Total PSA Levels: Data From the Baltimore Longitudinal Study of AgingUrologyVol. 77Issue 1PreviewTo describe the distribution and implications of prostate-specific antigen velocity (PSAV) by prostate-specific antigen (PSA) in an unselected population. A PSAV >0.35 and >2.0 ng/mL/y have been associated with an increased risk of prostate cancer (CaP) death more than 10 years and 1 year before diagnosis, respectively. It is unknown how frequently PSAVs of this magnitude occur in community men. Full-Text PDF ReplyUrologyVol. 77Issue 1PreviewThe Editorial Comment raises an important concern about confounding of prostate-specific antigen (PSA) kinetics from biological variability in the PSA measurement. Surprisingly, we found that this was less of an issue than expected. In our community-based population, only ∼1% of PSAV values exceeded 0.4 ng/mL/y in healthy men with PSA levels <3 ng/mL. Thus, if this cutpoint were used to determine the need for prostate biopsy at low PSA levels, few men would be subjected to unnecessary biopsy on the basis of PSA variability alone. Full-Text PDF
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