Prostate-specific antigen velocity, and prostate cancer Gleason grade and stage: Pinsky PF, Andriole G, Crawford ED, Chia D, Kramer BS, Grubb R, Greenlee R, Gohagan JK, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD

Abstract

Increased preoperative prostate-specific antigen (PSA) velocity (PSAV) has been associated with increased prostate cancer mortality and higher Gleason scores. The authors evaluated the relation between PSAV, biopsy Gleason score, and pathologic stage in men who were enrolled in a prostate cancer screening trial. Data were analyzed from 1,441 men who were enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who received ≥2 PSA screens and were diagnosed with prostate cancer within 1 year of the last screen. PSAV was estimated by using all screening PSA values within 6 years pre-diagnosis. Both PSA and PSAV were related to biopsy Gleason score. The multivariable odds ratios (OR), controlling for PSA and demographics, for having a Gleason score of 7 to 10 were 1.3 (95% confidence interval [95% CI], 0.9–1.9), 2.2 (95% CI, 1.5–3.3), and 2.3 (95% CI, 1.4–3.9) for men with PSAV values from 0.5 to 1 ng/ml per year, from 1 to 2 ng/ml per year, and >2 ng/ml per year, respectively, compared with men who had PSAV values <0.5 ng/ml per year. The median PSAV was 0.60 ng/ml per year for men with Gleason scores from 2 to 6 vs. 0.84 ng/ml per year for men with Gleason scores from 7 to 10 (P < .0001). Among 658 men who underwent prostatectomy, both PSA and PSAV were associated with advanced pathologic stage in univariate analyses; however, when the analysis controlled for clinical stage and biopsy Gleason score, the associations of PSA and PSAV were no longer statistically significant. PSAV and PSA levels were associated independently with biopsy Gleason score. Among men who underwent prostatectomy, PSAV and PSA were not predictive of advanced pathologic stage when the analysis was controlled for biopsy Gleason score and clinical stage. It cannot be determined yet whether PSAV is predictive of long-term prostate cancer outcome in this cohort.