PSA velocity for assessing prostate cancer risk in men with PSA levels between 2.0 and 4.0 ng/ml.

Objectives: To evaluate the use of prostate-specific antigen (PSA) velocity (PSAV) in assessing prostate cancer risk among men with PSA levels less than 4.0 ng/mL.

Methods: The relative risk of, and cumulative probability of freedom from, prostate cancer by PSAV was evaluated in 89 male participants (21 with cancer and 68 controls) of a longitudinal aging study-the Baltimore Longitudinal Study of Aging (National Institute on Aging)-who had serial PSA levels between 2.0 and 4.0 ng/mL for at least 18 months. The relative risk was estimated from a Cox proportional hazards regression model, and the disease-free probability was determined by Kaplan-Meier survival analysis. The sensitivity and specificity of PSAV were calculated as a measure of test validity.

Results: The sensitivity and specificity of a PSAV of 0.1 ng/mL per year was 81% and 50%, respectively. The relative risk of prostate cancer was 6.53 (range 1.90 to 22.51) when the PSAV was 0.1 ng/mL per year or more compared with a PSAV of less than 0.1 ng/mL per year (P = 0.0029). At 10 years, the cumulative probability of freedom from prostate cancer was 97.1% (range 91.4% to 100%) and 35.2% (range 14.0% to 56.4%) when the PSAV was less than and greater than 0.1 ng/mL per year, respectively. Survival curves began to differ at less than 5 years after the baseline PSAV determination.

Conclusions: The association between PSAV and the subsequent risk of prostate cancer suggests that the PSAV may be useful in the risk assessment of men with lower PSA levels.