Prostate news article, October 2004
| PRE-OPERATIVE
PSA VELOCITY AND THE RISK OF DEATH FROM PROSTATE CANCER AFTER
RADICAL RETROPUBIC PROSTATECTOMY
Anthony V D'Amico, William J Catalona et al, Harvard University and Chicago Hospital Published in: New England Journal of Medicine 2004; 351:125-35 Reviewed by: Dr Claire Taylor, MRCP FRCS |
This paper looks at whether men who ultimately have a high risk of death from prostate cancer can be identified before undergoing a radical retropubic prostatectomy (RRP) and hence prevent non-curative operations. The authors chose to look at PSA velocity, which is how quickly the PSA increases over time, because several studies have already linked a PSA rise of greater than 2ng/ml per year with poor a outcome in prostate cancer. Using PSA velocity has the advantage of being easily measured, as it requires only a series of simple blood tests.
A group of 1095 men had their PSA velocities calculated before they had their RRP and their post-operative performance was then assessed for up to 5 years. It was shown that those men with a high PSA velocity were dying significantly sooner, as well as suffering a higher rate of recurrence of their prostate cancer, when compared with men having a lower PSA velocity. Unfortunately, the type of statististics used could not put a value this increased risk.
Despite the evidence of this study suggesting that men with a high pre-operative PSA velocity should not be offered curative surgery, the authors point out that they do not know if a similar picture would be seen if both groups of men had been given hormone treatment instead. They suggest that a trial comparing RRP treatment against hormone treatment in men having a high PSA velocity should be undertaken before any definitive guidelines can be issued.