Two studies have examined whether additional testing and screening techniques will be valuable for stratifying patients at greater risk of developing life-threatening prostate cancer or cervical abnormalities.

H. Ballentine Carter and colleagues showed that a high prostate-specific antigen (PSA) velocity (rate of change) seen prior to prostate cancer diagnosis might help identify men at a greater risk of developing life-threatening disease. The authors examined samples taken from 980 men; 856 without prostate cancer, 104 with prostate cancer (who were either alive or who subsequently died of another cause) and 20 who subsequently died from prostate cancer. PSA velocity measured 10–15 years before diagnosis was shown to be associated with cancer-specific survival 25 years later. Men who had a low PSA velocity (≤0.35 ng ml−1per year) had a significantly higher level of survival (92%) compared with those who had a PSA velocity >0.35 ng ml−1per year (54% overall survival). Similar observations were made for relative risk of prostate cancer death. Although PSA velocity might be able to identify men at a higher risk of death from prostate cancer at a stage when they have more curable disease, the study had several limitations, including a relatively small sample size with prostate cancer, and no comparison of the value of PSA velocity versus PSA levels. Ongoing large randomized trials should help more definitively address the value of PSA velocity for prostate cancer prognosis.

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