It was ten years ago now that Bill Littlefield had a routine screening blood test called PSA-prostate specific antigen. The PSA test is used to detect prostate cancer. A PSA of four or higher indicates the need for a workup for this disease.

Bill says, “My PSA was 6.6 which is not too good. They recommended I get my prostate removed, the radical prostatectomy, so I went with that. While I was told the cancer was contained, it actually hadn’t been and had broke through the prostate wall and some cells got loose.”
Now, a new study in the New England Journal of Medicine says in the year just before diagnosis a rise in the PSA of more than two points is predictive of those who have a much worse prognosis.
These patients were seven times more likely to have cancer that ended up spreading to the lymph nodes, and overall they were more likely to die from prostate cancer.
This rise is called the PSA velocity.
Dr. E. Roy Berger, a medical oncologist and prostate cancer expert, says, “PSA velocity has been debated over the years, in general it is felt to be somewhat predictive of men who are suspicious of having prostate cancer, if it goes up more than 0.75 ng/ml/year. We use it to decide whom to biopsy and whom not to biopsy, and we use it as a mechanism to determine who is relapsing from cancer and who is not.”
If indeed the person does have an elevated PSA velocity before diagnosis, then the patient might decide to hold off on getting a radical prostatectomy, where the prostate is removed. It’s an aggressive surgery that ends up causing, in many patients, incontinence and impotence.
“It sort of interfered with my sex life,” states Bill.
A less aggressive approach, such as radioactive seed placement might help slow the course of disease just as well, given that not even the surgery will be curative with such a high PSA velocity.
Dr. Berger believes one should talk to several experts before deciding the treatment course. “I think every prostate cancer patient today should be seen by an urologist, a radiation oncologist, and a medical oncologist,” Dr. Berger advises.
And while it’s a disturbing thought that one might discover his PSA is rapidly rising and what that might portend, it’s better to know than not to know. “I personally get my PSA checked once a year and have a digital rectal exam. In balance I’d rather err on the side of being careful than being an ostrich and stick my head in the sand,” says Dr. Berger.
Many experts recommend PSA testing starting at age 50, earlier if you have a close relative with prostate cancer, or if you’re African American. In these cases, testing should start between ages 40 and 45.

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