PSA History

The pattern of your PSA history can be an important factor for evaluating your risk. Start by reviewing your records and making a list of all PSA values and dates. For an extensive discussion of this topic, see the fifth section, “The Use the PSA and Derivative Tools in Diagnosis and Staging” of our Insights articles “What We Should Have Learned about PC in the Last 10 Years – Part Three”

The following concepts were discussed under PSA Blood Test

PSA Doubling Time (PSADT)

PSADT can provide an indication of risk of progression. Egawa et al[1] examined PSADT before radical prostatectomy and found that a doubling time of 3 years or less was more common with disease that was not organ-confined at radical prostatectomy. Also, in a watchful-waiting cohort, McLaren et al[2] found that approximately 50% of patients with a PSADT of <18 months progressed within 6 months. You can calculate your PSA doubling time using one of the calculators below, and recalculate with each new PSA test.

PSA Velocity (PSAV)

An increase of PSA > 2 ng/ml in one year is a high risk factor. D’Amico et al.[3] reported that a rise in PSA of more than 2 ng/mL/y before surgery identified patients at greater risk for prostate cancer mortality at 7 years. No patients whose PSA increased less than 2.0 ng/mL/y before surgery died of the disease at 7 years. Berger et al.[4] study also showed that in men eventually diagnosed with PC, the PSAV starts to increase in the six-year period prior to diagnosis.

PSA Density (PSAD)

PSAD is a calculation of the PSA value divided by the gland volume (in cubic centimeters) from ultrasound (or prostatectomy). Saidi et al[5] reported organ-confined disease for PSAD <0.2 = 76% vs. PSAD >0.2 = 47%. Radwan et al[6] concluded that PSAD is a strong predictor of advanced pathologic features and biochemical failure after radical prostatectomy.

Related resources:

Memorial Sloan Kettering MSKCC nomograms
References

1. Egawa et al. Use of pretreatment prostate-specific antigen doubling time to predict outcome after radical prostatectomy. Prostate Cancer Prostatic Dis. 2000 Dec;3(4):269-274.
2. McLaren DB et al. Watchful waiting or watchful progression? Prostate specific antigen doubling times and clinical behavior in patients with early untreated prostate carcinoma. Cancer 1998;82:342-348.
3. D’Amico AV et al. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004;351:125-135.
4. Berger AP et al: Large-scale study of clinical impact of PSA velocity: long-term PSA kinetics as method of differentiating men with from those without prostate cancer. Urology 69:134-8, 2007.
5. Saidi S et al. Does prostate specific antigen density correlates with aggressiveness of the prostate cancer? Hippokratia. 2009 Oct;13(4):232-6.
6. Radwan MH et al. Prostate-specific antigen density predicts adverse pathology and increased risk of biochemical failure. Urology 2007 Jun;69(6):1121-7.

Page updated 8/1/11