A rise in the prostate-specific antigen (PSA) level of more than 2 ng/ml during the year prior to diagnosis has been associated with an increased risk of prostate cancer-specific mortality (PCSM) following radical prostatectomy (RP) or radiation therapy. We evaluated whether the proportion of men with a PSA velocity >2 ng/ml/year leading up to a prostate cancer diagnosis has changed significantly during the PSA era.
Materials/Methods
The study population included 1095 men from a prospective prostate-cancer screening study who underwent RP between November, 15, 1989 and May 22, 2002. For the purposes of analysis, the study period was divided into early (before 1995), middle (1995–1998), and late (after 1998) PSA eras. Throughout the study, PSA samples were analyzed at a single laboratory and the PSA velocity was calculated by linear-regression of values from the 12 months prior to diagnosis. The chi-square and Kruskal-Wallis tests were used to compare clinical parameters between men diagnosed during the different eras. Logistic regression was used to evaluate whether there was an association between the year of diagnosis and the proportion of men presenting with a PSA velocity >2 ng/ml/year.
Results
Of the 1095 men, 262 (24%) had a PSA velocity >2 ng/ml/year in the year prior to diagnosis. There was a significant reduction (odds ratio: 0.84 [95% CI: 0.78–0.87; p < 0.001]) in the proportion of men presenting with a PSA velocity >2 ng/ml/year during the study period. Specifically, 118 (35%) men presented with a PSA velocity >2 ng/ml/year in the early period, compared to only 116 (22%) and 28 (12%) in the middle and late periods, respectively (p < 0.001). Over the three eras, there was also a significant reduction in the median age, clinical stage, and PSA level at diagnosis, and a non-significant trend toward a lower proportion with Gleason score 8 to 10 disease (see Table).
Conclusions
Men who have been serially screened using both PSA and digital rectal examination are significantly less likely to present with a 2-point rise in their PSA level during the year prior to diagnosis. This association lends support to the hypothesis that serial screening with PSA could lead to a decrease in PCSM.
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