PSA rise must be used with other cancer indicators

RAPID rises in prostate-specific antigen (PSA) can help identify men with prostate cancer but only in conjunction with other indicators, an Australian expert says.

The comments followed US research looking at whether a PSA velocity over 0.35 ng/ml/year should prompt a biopsy even in the absence of other risk factors, as recommended in some US guidelines.

In around 5000 men who had yearly PSA tests and underwent biopsies in the control arm of the Prostate Cancer Prevention Trial, they found a strong association between high PSA velocity and positive biopsies.

PSA velocity over two years had specificity comparable to a PSA cutpoint of 2.5 ng/ml but the PSA cutpoint was more sensitive.

The authors concluded PSA velocity did not add an important predictive value to PSA.

Professor Phillip Katelaris, director of the Prostate Cancer Foundation of Australia, said the study may not have shown PSA velocity was useful because the level was