PSA Velocity's Clinical Usefulness Remains Unclear

PSA velocity has been the subject of much research and debate since the beginning of the PSA screening era. Initially, PSA velocity was proposed for use in men with moderately elevated PSA levels in order to decrease the number of unnecessary biopsies. But often PSA velocity is being used in men with low PSA levels, effectively increasing the number of men who are referred to have a biopsy.

Ruth Etzioni, Ph.D., of the Fred Hutchison Cancer Research Center in Seattle and colleagues reviewed several recent articles on PSA velocity. They point out in their commentary the important differences between studies of PSA velocity in the cancer screening setting and studies of PSA velocity and prostate cancer progression after diagnosis. These differences lead them to question whether PSA velocity is useful for early detection of prostate cancer.

No studies to date have addressed the costs and benefits of using PSA velocity for prostate cancer screening. "One of the main goals of this commentary has been to reconcile some of the inconsistencies across studies by highlighting features of study design and potential sources of bias that might explain why different types of studies have produced differing results," the authors write.

Citation: Etzioni RD, Ankerst DP, Weiss NS, Inoue LYT, Thompson IM. Is Prostate-Specific Antigen Velocity Useful in Early Detection of Prostate Cancer" A Critical Appraisal of the Evidence. J Natl Cancer Inst 2007; 99:1510-1515