It is argued that a rapidly rising PSA may indicate a greater risk of diagnosis of prostate cancer even if PSA levels are low. Some guidelines do incorporate PSA velocity cut points as an indication for biopsy.

The aim of one study was to evaluate whether PSA velocity indeed enhances the prediction of biopsy outcome in a large, representative, population-based cohort.

There were 2742 screening-arm participants with PSA less than 3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer ( ERSPC ) in Rotterdam ( NL ) or Göteborg ( SE ) who were subsequently biopsied due to elevated PSA.

The conclusion of the study is that PSA velocity adds very little predictive value for determining the outcome of a first prostate biopsy in men with elevated PSA. These findings are very similar to those of earlier studies. Accordingly, researchers see little justification for formal calculation of PSA velocity and subsequent incorporation into a statistical model, and no justification for velocity cut points, in determining indication for biopsy. This suggests that current guidelines on the use of PSAV to guide biopsy should be revised. However, researchers encourage use of clinical judgment in decisions about biopsy: a sudden rise in PSA might suggest prostatitis, triggering further evaluation of symptoms, laboratory tests, or empirical antibiotic therapy. If evidence of prostatitis is absent, a biopsy might well be advisable. This type of sophisticated, sequential, clinical decision making cannot easily be evaluated in analyses of population-based screening studies.

Source: European Association of Urology, 2009

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