PSA doubling time versus PSA velocity to predict high-risk prostate cancer: data from the Baltimore Longitudinal Study of Aging.

Abstract

Our group has previously shown that prostate-specific antigen (PSA) velocity (PSAV) is associated with the presence of life-threatening prostate cancer. Less is known about the relative utility of pretreatment PSA doubling time (PSA DT) to predict tumor aggressiveness. To compare the utility of PSAV and PSA DT for the prediction of life-threatening prostate cancer. From the Baltimore Longitudinal Study of Aging, we identified 681 men with serial PSA measurements. Receiver operating characteristic analysis was used to evaluate the relationship between PSAV, PSA DT, and the presence of high-risk disease. Within the period of 5 yr prior to diagnosis, PSAV was significantly higher among men with high-risk or fatal prostate cancer than men without it. By contrast, PSA DT was not significantly associated with high-risk or fatal disease. On multivariate analysis, including age, date of diagnosis, and PSA, the addition of PSAV significantly improved the concordance index from 0.85 to 0.88 (p<0.001), whereas PSA DT did not. These data suggest that PSAV is more useful than PSA DT in the pretreatment setting to help identify those men with life-threatening disease.