Why Does the Prostate Specific Antigen (PSA) Velocity Matter?

This test may be able to spot fast growing cancers

Male doctor checking senior patient with stethoscope
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The Prostate Specific Antigen test, also known as PSA velocity, has been used extensively around the world to detect and monitor prostate cancer.

For many years, physicians have been using the absolute value of PSA to determine a man's risk for prostate cancer or whether his cancer has returned or progressed. As of 2016, however, it has become more obvious that the rate of change of the PSA level, or PSA velocity, may be just as important as the raw number itself.

The New Role for PSA Velocity

Many prostate cancer experts now consider not only the PSA level but also how fast it is changing when determining whether to order further tests, when to start treatment or what to tell their patients about prognosis.

Numerous studies have now shown that a high PSA velocity (for example rapid doubling time of PSA or a rise of 0.35 ng/mL or more per year) may signal a rapidly growing cancer regardless of how high the absolute PSA level is.

For example, a man goes for his routine screening PSA test and it comes back at 2.0 ng/mL. He is otherwise healthy and his physician is unconcerned by the result since 2.0 is not a "high" level in most cases. But last year his PSA level was 1.0 ng/mL and the year before it was 0.5 ng/mL.

Should these results worry him or his doctor?

Based on mounting evidence, the answer is likely "yes." In this example, a relatively low PSA level of 2.0 could be waved off as "normal." However, this man's PSA has doubled each year for two years, making the number significant even if it falls within the "normal" range. This is a high rate of change of PSA (such as a high PSA velocity) and could likely signify a rapidly growing cancer.

In short, the doctor in this scenario should take swift action to get this patient further medical treatment.

Wrapping Up

It is, therefore, important to keep track of your own PSA levels over the years and alert your doctor to any trends that you notice, especially if you change doctors and are not sure how familiar your new doctor is with your medical history. Physicians see thousands of patients a year and may simply overlook the fact that your PSA has been increasing rapidly.

Don't hesitate to question your doctor about your PSA velocity results or to request further testing or analysis. This goes double if you belong to a high-risk group, such as African American men, or have a family history of prostate cancer.

If your doctor takes issue with this line of questioning or appears to be unconcerned about your PSA velocity results, even if they appear to be rising markedly as they did in the above example, consider switching physicians. Your life is far too precious to take the risk that everything is normal, when your PSA levels may be revealing otherwise. If you don't switch doctors, at least consider getting a second or third opinion about your PSA velocity and medical history.

The persistence of patients has saved countless lives. 

View Article Sources
  • Carter HB, Ferrucci L, Kettermann A, et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. Journal of the National Cancer Institute 2006; 98(21):1521–1527.
  • Ng MK, Van As N, Thomas K, et al. Prostate-specific antigen (PSA) kinetics in untreated, localized prostate cancer: PSA velocity vs PSA doubling time. BJU Int. 2008 Oct 16.