Significance of preoperative PSA velocity in men with low serum PSA and normal DRE

World J Urol. 2011 Feb;29(1):11-4. doi: 10.1007/s00345-010-0625-4. Epub 2010 Dec 14.


Objectives: A PSA velocity (PSAV)>0.35 ng/ml/year approximately 10-15 years prior to diagnosis is associated with a greater risk of lethal prostate cancer. Some have recommended that a PSAV>0.35 ng/ml/year should prompt a prostate biopsy in men with a low serum PSA (<4 ng/ml) and benign DRE. However, less is known about the utility of this PSAV cutpoint for the prediction of treatment outcomes among men undergoing radical prostatectomy (RP).

Methods: Between 1992 and 2007, 339 men underwent RP at our institution with a preoperative PSA<4 ng/ml, benign DRE, and multiple preoperative PSA measurements. PSAV was calculated by linear regression analysis using all PSA values within 18 months prior to diagnosis. Kaplan-Meier survival analysis was performed, and biochemical progression rates were compared between PSAV strata using the log-rank test.

Results: The preoperative PSAV was >0.35 ng/ml/year in 124 (36.6%) of 339 men. Although there were no significant differences in clinico-pathological characteristics based upon PSAV, men with a PSAV>0.35 ng/ml/year were significantly more likely to experience biochemical progression after RP at a median follow-up of 4 years (P=0.022).

Conclusions: In this low-risk population with a preoperative PSA<4 ng/ml and benign DRE, approximately 1/3 had a preoperative PSAV>0.35 ng/ml/year. Physicians should carefully monitor men with a preoperative PSA>0.35 ng/ml/year as they are at increased risk of biochemical progression following RP.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Digital Rectal Examination*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Preoperative Period*
  • Prognosis
  • Prostate-Specific Antigen / blood*
  • Prostatectomy
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / surgery
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors


  • Prostate-Specific Antigen