Title: 485: PSA-Velocity Increases Continuously in the Years Prior to Diagnosis of Prostate Cancer
Abstract: INTRODUCTION AND OBJECTIVE: The aim of the following study was to evaluate the distribution of PSA values for several age groups in order to determine "normal total serum PSA levels" using the Tyrol PSA Screening database.Furthermore these data are disscussed with regards to PSA velocity ( Berger et al., The Prostate 2005 1 :64 (3): 240-5).METHODS: A total of 228.792PSA tests performed between October 1993 and September 2000 were evaluated.13.254PSA were excluded from the evaluation since these men reported urinary symptoms.Using Fractional Polynomials to derive the percentiles of the PSA distribution at each given age a linear model to describe the relationship between the logarithm of PSA and age was fitted.The mean PSA velocity per year for the various age groups was calculated and a PSA velocity of 0.03 nglmllyear was considered normal.RESULTS: A quadratic relationship between the logarithm of total serum PSA and age was found.Median total serum PSA increases with age from 0. 7 nglml among men aged 45 to 1.6 among men aged 75.Eighty per cent of men aged 55 have a total serum PSA in the range 0 -1.8 nglml, while the corresponding range for men aged 65 is 0-3.2 nglml.PSA velocity for men in the 50th percentile did not exceed 0.04 nglmllyear wheras an increase in PSA velocity was noticed for men in the 80th to 95th percentile.The percentiles of the PSA distribution as well as the PSA velocity at a variety of ages are shown in the table below.CONCLUSIONS: The data, based on an extremely large number of PSA tests carried out on a population of asymptomatic men show, that median "normal" PSA are low and increase with age.Since men with a PSA velocity s 0.04 nglmllyear do not develop prostate cancer, these data can be helpful interpreting PSA velocity beginning at a certain age, to more accurately inform screening volunteers about their risk of having prostate cancer.Moreover these data suggest, that biopsy recommendations based on a simple cutoff level of 4 nglml are no more appropriate.In the future we should use PSA more intelligently, e.g.PSA determination at an earlier age (40 years), low PSA approach, PSA algorithm, PSA velocity. yrs.55 yrs.65 yrs.75 yrs.