Preoperative PSA Velocity Is an Independent Prognostic Factor for Relapse After Radical Prostatectomy Deep A. Patel, Joseph C. Presti Jr, John E. McNeal, Harcharan Gill, James D. Brooks, and Christopher R. King A B S T R A C T Purpose Preoperative prostate-specific antigen (PSA) velocity (PSAV), or the rate of PSA rise before diagnosis, predicts for risk of cancer death after radical prostatectomy (RP). We evaluated the relative merit of established preoperative factors, including biopsy indices and preoper- ative PSAV, for their impact on relapse after RP. Patients and Methods The outcomes of 202 men who underwent RP were reviewed. Biopsies were characterized for grade, percentage positive cores, and total linear tumor length. Surgical specimens were characterized for cancer volume, relative percentage by grade, extracapsular extension, and margin status. Univariate and multivariate analyses were performed with respect to relapse-free survival after RP. Results Thirty-one patients relapsed after RP (defined as PSA  0.2 ng/mL), with a median time to failure of 16 months. Median follow-up was 48 months. Kaplan-Meier relapse-free survival at 5 years was 89%, compared with 73% for PSAV  2 v  2 ng/mL/year (P = .003). On multivariate analysis, only the biopsy Gleason sum (P  .008; relative risk,  4.8) and the preoperative PSAV (P  .04; relative risk, 3.0 to 4.7) remained significant. Patients with a PSAV of  2 ng/mL/year were more likely to be pT3 (P = .007), have positive margins (P = .01), have tumors  1 mL (P = .05), and possess  10% grade 4/5 tumors (P = .04). Conclusion The preoperative PSAV is a significant independent clinical factor predicting for relapse after RP and also predicts for larger, more aggressive, and more locally advanced tumors. Its inclusion will be useful in risk stratification, evaluation for alternatives to surgery, and patient selection for neoadjuvant or adjuvant therapies as part of randomized clinical trials. J Clin Oncol 23:6157-6162. © 2005 by American Society of Clinical Oncology INTRODUCTION A recent study showed that the rate of rise in prostate-specific antigen (PSA) during the year before the diagnosis of prostate cancer (the annual PSA velocity [PSAV]) predicted the risk of recurrence and the risk of prostate cancer death after radical prostatectomy (RP). 1 After adjusting for known clinical factors (clinical T stage, initial PSA level, and biopsy Gleason score), the PSAV remained an independent factor. In the current era of PSA screening and extended biopsy schemes, more men are diagnosed with lower PSA levels, nonpalpable tumors, and smaller tumors; thus, the relative usefulness of the pre- viously established clinical factors such as T stage and PSA level will diminish. As a sepa- rate measure of biologic aggressiveness, the PSAV should have an increasing role in guid- ing treatment recommendations and in pa- tient selection for adjuvant therapies. To further evaluate the usefulness of PSAV, we examined the relapse rate after RP with a From the Departments of Radiation Oncology and Urology, Division of Urologic Oncology, Stanford University School of Medicine, Stanford, CA. Submitted January 19, 2005; accepted May 18, 2005. Address reprint requests to Christopher R. King, PhD, MD, Department of Radi- ation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; e-mail: christopher.king@stanford.edu. © 2005 by American Society of Clinical Oncology 0732-183X/05/2325-6157/$20.00 DOI: 10.1200/JCO.2005.01.2336 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 23  NUMBER 25  SEPTEMBER 1 2005 6157 Downloaded from jco.ascopubs.org on June 14, 2013. For personal use only. No other uses without permission. Copyright © 2005 American Society of Clinical Oncology. All rights reserved.