Oncology PSA Velocity Is Associated With Gleason Score in Radical Prostatectomy Specimen: Marker for Prostate Cancer Aggressiveness Stacy Loeb, Douglas E. Sutherland, Anthony V. D’Amico, Kimberly A. Roehl, and William J. Catalona OBJECTIVES Conflicting evidence has been reported on the association of prostate-specific antigen velocity (PSAV) with Gleason score in prostate needle biopsy specimens. The Gleason score is an important prognostic indicator for men with prostate cancer, and, in modern practice, it frequently affects treatment decisions. To our knowledge, the relationship between preoperative PSAV and Gleason score in the radical prostatectomy specimen has not been formally demon- strated. METHODS A total of 1049 men treated with radical prostatectomy had data on PSAV and Gleason score. Statistical analysis was performed to examine the relationship between the preoperative PSAV and the prostatectomy Gleason score and other adverse tumor features. RESULTS The median preoperative PSAV was 0.84, 0.97, and 1.39 ng/mL/y in men with a Gleason score of 6, 7, and 8-10, respectively (P = .05). A PSAV greater than 2 ng/mL/y was significantly associated with a prostatectomy Gleason score of 7 or greater on univariate and multivariate analysis. In addition, the preoperative PSAV was significantly lower in men with organ-confined disease (0.82 vs 1.17 ng/mL/y, respectively, P = .002). CONCLUSIONS Our results have further validated PSAV as a marker for prostate cancer aggressiveness. The preoperative PSAV was a significant independent predictor of the Gleason score and non– organ- confined disease in the radical prostatectomy specimen. Thus, PSAV could be useful in treat- ment decision-making and in assessing the likelihood of long-term cancer control in men with prostate cancer. UROLOGY 72: 1116 –1120, 2008. © 2008 Elsevier Inc. I t has been estimated that 218 890 new cases of prostate cancer (CaP) will have been diagnosed in 2007. 1 The prevalence of CaP as a result of prostate- specific antigen (PSA)-based screening has led to con- siderable investigation into clinical parameters that could help predict the aggressiveness of disease. 2 Such markers would be useful for patient counseling and clinical deci- sion-making, such as the choice between immediate in- tervention and active monitoring. The Gleason score is an important variable for treat- ment planning and prognostication in men with newly diagnosed CaP, regardless of the form of treatment under consideration. For men considering radical prostatectomy (RP), the Gleason score has been used in several nomo- grams to predict the likelihood of adverse pathologic features and biochemical progression postoperatively. 3,4 Similarly, the Gleason score at diagnosis is a significant predictor of relapse-free survival after brachytherapy and external beam radiotherapy. 5 Furthermore, the Gleason score is a useful indicator of disease aggressiveness for patients and physicians considering conservative man- agement. For example, Albertsen et al. 6 reported on 767 men with CaP who elected watchful waiting. After more than 20 years of follow-up, they reported only six CaP deaths per 1000 person-years for men with a Gleason score of 2-4. In contrast, men with Gleason score 8-10 tumors had 121 deaths per 1000 person-years within 10 years of diagnosis. Although there is little debate that the Gleason score is linked to treatment outcomes, the search continues for additional variables to more accurately identify those cancers that pose the greatest threat. Furthermore, the biopsy Gleason score is subject to sampling errors, and a considerable proportion of patients treated with RP have their score upgraded in the RP specimen. Thus, addi- This study was supported in part by the Urological Research Foundation and Beckman Coulter, Inc., Fullerton, CA. From the Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Urology, George Washington University School of Medicine, Washington, DC; Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois Reprint requests: William J. Catalona, M.D., Department of Urology, Northwestern University Feinberg School of Medicine, 675 North Saint Clair Street, Suite 20-150, Chicago, IL 60611. E-mail: wcatalona@nmff.org Submitted: September 3, 2007, accepted (with revisions): January 10, 2008 1116 © 2008 Elsevier Inc. 0090-4295/08/$34.00 All Rights Reserved doi:10.1016/j.urology.2008.01.082