MAKING PSA MORE MEANINGFUL: PSA VELOCITY

Perhaps the most promising approach to PSA is to look at PSA velocity—its rate of change from year to year. The supposition is this: If cells double at a much faster rate in prostate cancer than in BPH, and if prostate cancer produces more PSA than BPH does, it’s likely that PSA’s yearly rate of change will be much greater in a man with prostate cancer than in a man with BPH. In other words: It stands to reason that if a man’s PSA is going up, he has a cancer—and that cancer is probably growing.

In one study, researchers at Johns Hopkins made use of a massive data base called the Baltimore Longitudinal Study of Aging. (Since it was begun in 1958, about one thousand five hundred men have participated in this study, returning every other year for physical examinations and a battery of medical tests. Their blood samples from every checkup are stored for future studies.) The investigators looked at three groups of men who were involved in this study— those with BPH, those with prostate cancer, and a control group of men with no prostate disease. Looking at twenty years’ worth of stored blood samples, investigators found that the men with prostate cancer had “significantly greater rates of change in PSA levels than those without prostate cancer up to ten years before diagnosis.”” In other words, by tracking changes in PSA levels, they were able to detect prostate cancer years before it could be diagnosed by other means. For example, at five years before diagnosis—when PSA levels weren’t appreciably different between men with BPH and men with prostate cancer— there was already a big difference in PSA velocity in men who turned out to have prostate cancer versus men who had BPH and the control group.

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