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  • PSA velocity > 2.0 and assessing seriousness of prostate cancer

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    Old 12-13-2007, 04:12 PM   #1
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    PSA velocity > 2.0 and assessing seriousness of prostate cancer

    On Tuesday night a panel of three respected local doctors presented updates in their fields and answered questions for our Us Too support group. One was a urologist, one a radiation oncologist, and the third was a medical oncologist. None specialize in prostate cancer, but all have many prostate cancer patients in their practices.

    It was very interesting that both the radiation oncologist and the medical oncologist each chose to emphasize as one of his updates the importance of PSA velocity in assessing the seriousness of prostate cancer. Just a few years ago, PSA velocity was acknowledged as something to consider, but it hardly ranked with the number of cores and percent of cores and the percent of each core that was cancer, let alone with the big three: baseline PSA at diagnosis, the Gleason Score, and the clinical stage.

    The change is mainly due to two research papers written by teams led by the well-known prostate cancer researcher/physician Dr. Anthony D'Amico. The first, published in the New England Journal of Medicine in July of 2004, demonstrated that, for radical prostatectomy patients, whether the PSA increased by up to 2.0 or more than 2.0 in the year prior to diagnosis was a strong indicator of seriousness of the case and was independent of the baseline PSA, Gleason Score and stage. Having such a high velocity PSA resulted in many times greater death rates from prostate cancer. The second, published in July of 2005 in the Journal of the American Medical Association, showed a similar impact of a PSA velocity of greater than 2.0 on patients who elected radiation therapy. I've reviewed complete copies of these papers, and the risks are even higher if the cancer can be felt (and not much different if the cancer cannot be felt ).

    I've noticed that at least two other research teams confirmed these findings.

    What this means is that we should pay attention to our PSA doubling time (PSADT) in the year prior to our diagnosis, if we have the PSA results needed to calculate the PSADT, as most of us do. (Not me, though, but it's a cinch mine was greater than 2.0 since my baseline PSA at diagnosis was 113.6.) Some of us who don't have precise information about it can make good estimates: we don't have to get an exact velocity, we mainly need to know whether it was up to 2.0 or greater.

    There is good news as well as bad news here. While we now have an additional factor to indicate higher than normal risk considering the other factors, the reverse is also true: if our PSAV was less than 2.0 in the year prior to diagnosis, especially if it was much less than 2.0, that is an indicator that we will probably do better than the statistics indicate based just on the more established factors, particularly the baseline PSA, the Gleason Score, and the clinical stage.

    We should also remember that having a PSAV greater than 2.0 before diagnosis need not put us in the middle of the bull's eye. With knowledge that we are at greater risk, we can make decisions that improve our chances.

    If you want to read abstracts of these studies, go to our free, taxpayer supported US Government website [url][/url], and search for " "Preoperative PSA Velocity" OR "Pretreatment PSA Velocity" AND Risk of Death from Prostate Cancer AND d'amico [au] ". In fact, you can click on the pages icon with the green heading to get a free complete copy of the paper. To read just the abstract, click on the authors lists.

    It is remarkable that this change in understanding of pre-diagnosis PSAV has penetrated the consciousness of doctors treating prostate cancer patients in so short a time.


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