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High Pretreatment PSA Velocity Predicts Worse Outcome

SA velocity significant in prostate cancer-specific mortality (PCSM) rates following treatment with radical prostatectomy (RP) or radiation therapy (RT). Dr. DAmico reviewed data from 948 men with localized prostate cancer who had one or more high-risk factors.

Dr. DAmico and his co-authors found that the most important single prognostic factor was PSA velocity. As expected, men who had multiple risk factors died from their disease significantly earlier than those with one factor. Of the men who underwent treatment with RP or RT, 44 percent and 28 percent, respectively, had pre-treatment PSA velocities of > 2 ng/ml/year as their only identified high-risk factor. Of those men who died with only one identified high-risk factor, 88 percent of RP-treated patients and 80 percent of RT-treated patients had pre-treatment PSA velocities of > 2 ng/ml/year.

In identifying this association, the authors also point out that other studies have found that time to death shortens as PSA velocity increases. This suggests that further research should examine using stratified PSA velocities to assess risk in men with localized disease.

"These findings," conclude the authors, "highlight the ability of a pre-treatment PSA velocity > 2 ng/ml/year alone to identify men with aggressive prostate cancer and in whom effective systemic treatment in addition to mono-therapy with RP or RT is needed to decrease PCSM rates."


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