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Rate of PSA rise predicts death from prostate cancer after surgery
  NEW YORK (Reuters Health) - The rate at which the PSA level rises during the year before prostate cancer is diagnosed appears to predict the risk of death after radical prostatectomy, new research suggests. A rise in PSA level of more than 2.0 ng/mL in a year was tied to a relatively high risk of death.
"This study provides, for the first time, solid evidence that PSA testing over a period of time is a reliable indicator of possible risk of death from prostate cancer," lead author Dr. Anthony V. D'Amico, from Massachusetts General Hospital in Boston, told Reuters.
The findings, which appear in The New England Journal of Medicine for July 8th, are based on a study of 1095 men who had PSA levels measured in the year before being diagnosed with localized prostate cancer and undergoing radical prostatectomy.
Compared with lower values, a PSA velocity of at least 2.0 ng/mL per year predicted a shorter time to death from prostate cancer (p < 0.001) and increased the risk of death from any cause (p = 0.01). Other predictors of a hastened death from prostate cancer included an increasing PSA level at diagnosis, a Gleason score of 8,9, or 10, and clinical tumor stage of T2.
In men with a high PSA velocity, the risk of death from prostate cancer and any cause at 7 years after surgery was also determined by PSA level, tumor stage, and Gleason score at diagnosis, the researchers note.
Contrary to current guidelines that consider PSA levels less than 4 ng/mL as safe, the new findings suggest that the absolute value may not be as important as the rate of change, senior author Dr. William Catalona told Reuters.
N Engl J Med 2004;351:125-135.


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