Does Prostate Growth Confound Prostate Specific Antigen Velocity? Data From The Baltimore Longitudinal Study Of Aging

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 27 Oct 2008 - 1:00 PDT

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UroToday.com - In the online version of the Journal of Urology, Dr. Stacy Loeb and colleagues reported on the relationship between prostate growth and PSA changes.

As background, PSA isoforms, PSA density, and PSA velocity all help to determine if an elevated PSA is due to prostate cancer (CaP) or benign causes. PSAV is greater in men with CaP compared to men with BPH. The database for this study was the Baltimore Longitudinal Study of Aging (BLSA), a prospective cohort of men, initiated in 1958. It includes 1,806 participants. Beginning in 1991, PSA and digital rectal examination were performed at regular intervals. In 1993, MRI was performed every 2 years. Men without evidence of CaP and at least 2 pelvic MRI scans with concurrent PSA measurements were eligible for inclusion in this analysis. A total of 242 men were included.

Prostate volume changes were determined by a 2-point method and changes in PSA were calculated as the rate of change between PSA at the first and last MRI, divided by time between these 2 measurements. Mean age of participants was 55 years and the AUA symptom score was 5.8. At the initial visit, the median PSA level was 0.9ng/ml, and after a median follow-up of 4.2 years, the median PSA level was 1.0ng/ml. Median prostate volume at the first MRI was 27cc and at the last MRI it was 30cc. The median rate of change in prostate volume was 0.6cc/year, corresponding to a 2.2% increase annually. The median PSA change in the overall cohort was 0.03ng/ml/year for participants with an initial prostate size <40cc, and 0.02ng/ml/year for men with a prostate of 40cc or greater. Using Pearson correlation coefficients, changes in PSA were not significantly correlated with the rate of change in volume per year. There was no significant correlation between a rising PSA and the rate of change in prostate volume per year. There was a small, but not significant correlation between rate of volume change and increasing age. Neither the first or last MRI, nor the rate of change in volume was associated with the rate of change in PSA.

Loeb S, Kettermann A, Carter HB, Ferrucci L, Metter EJ, Walsh PC
J Urol. 2008 Aug 14. Epub ahead of print.
doi:10.1016/j.juro.2008.06.033

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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