The potential role of PSA velocity in screening for prostate cancer has been unclear. However, recent data from the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) appears to confirm earlier suggestions that PSA velocity (the rate of increase in PSA over time) is not an independent predictor of risk for clinically significant prostate cancer.
During the first and second ERSPC screening rounds, PSA tests were performed on 2,217 men, and all these men underwent a biopsy during the second screening round in year 4 of the study. Their PSA velocities were calculated and their biopsy outcomes were classified as benign, possibly indolent prostate cancer, or clinically significant prostate cancer, according to predetermined criteria.
A total of 441 cases of prostate cancer were detected among these 2,217 men; 333 of the cases were classified as clinically significant and 108 as possibly indolent. The authors determined that the use of cut-off values for PSA velocity would have reduced the number of biopsies but would also have led to important numbers of missed (indolent and clinically significant) cases of prostate cancer.
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