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Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy

  • 0Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Mass 02215, USA. adamico@lroc.harvard.edu
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July 28, 2005

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July 28, 2005

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View abstract on PubMed

Summary

This summary is machine-generated.

Men with a rapid rise in prostate-specific antigen (PSA) velocity (>2.0 ng/mL/year) face a significantly higher risk of prostate cancer death after radiation therapy. This elevated risk applies even to men with low-risk disease, suggesting a need for intensified treatment strategies.

Area Of Science

  • Urology
  • Oncology
  • Medical Statistics

Background

  • A preoperative prostate-specific antigen (PSA) velocity exceeding 2.0 ng/mL/year is linked to a tenfold increase in prostate cancer mortality in men with localized disease undergoing surgery.
  • This study investigates the prognostic significance of PSA velocity in patients treated with radiation therapy (RT).

Purpose Of The Study

  • To determine if a PSA velocity greater than 2.0 ng/mL in the year preceding diagnosis is associated with prostate cancer-specific mortality after RT.
  • To evaluate the impact of high PSA velocity on mortality outcomes in localized prostate cancer patients receiving radiation.

Main Methods

  • A cohort of 358 men treated with RT for localized prostate cancer between 1989 and 2002 was analyzed.
  • Cox regression multivariable analysis was employed to assess the association between PSA velocity (>2.0 ng/mL/year) and mortality, controlling for other prognostic factors.
  • Outcomes were stratified based on disease risk (low-risk vs. higher-risk) and PSA velocity.

Main Results

  • A PSA velocity greater than 2.0 ng/mL/year was significantly associated with a 12-fold increased risk of prostate cancer-specific mortality (adjusted HR, 12.0; P = .001) and a 2.1-fold increased risk of all-cause mortality (adjusted HR, 2.1; P = .005).
  • For men with low-risk disease, a PSA velocity >2.0 ng/mL/year corresponded to a 7-year prostate cancer-specific mortality of 19%, compared to 0% for those with lower PSA velocity.
  • In men with higher-risk disease, the 7-year mortality rates were 24% (PSA velocity >2.0 ng/mL/year) versus 4% (PSA velocity ≤2.0 ng/mL/year).

Conclusions

  • Elevated PSA velocity (>2.0 ng/mL/year) prior to diagnosis is a significant predictor of increased prostate cancer mortality following radiation therapy, even in low-risk cases.
  • Men with high PSA velocity undergoing RT, particularly those in good health, may benefit from combined androgen suppression therapy to improve survival outcomes.
  • PSA velocity serves as a critical prognostic marker in localized prostate cancer, informing treatment decisions and risk stratification.

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