PSA velocity (PSAV) is associated with Gleason grade group (GG) progression and risk of metastases among both Black and White men on prostate cancer (PCa) active surveillance, a new study finds. Black men, however, may experience progression at lower PSAV.
Among 5296 patients with localized, low-risk PCa managed with active surveillance in the 2001-2015 Veterans Health Administration database, 3919 (74.0%) were White (mean age, 65.7 years) and 1377 (26.0%) were Black (mean age, 62.8 years). GG progression occurred in 38.9% of the cohort: 1980 patients at the time of restaging biopsy and 82 patients at the time of prostatectomy. The cumulative 7-year incidence of progression to GG2 or higher was 43.2%. Progression to GG3 or higher occurred in 728 patients (13.7%). Metastases developed in 54 men (1.0%).
On multivariable analysis, higher PSAV was significantly associated with a 32%, 51%, and 38% increased risk of progression to GG2, GG3, and metastases, respectively, J. Kellogg Parsons, MD, MHS, of the University of California, San Diego, and colleagues reported in JAMA Network Open..
Optimal PSAV thresholds that were associated with progression were significantly lower for Black patients (0.44 ng/mL/y) compared with White patients (1.18 ng/mL/y).
“These data suggest that serial PSAV measures may potentially substitute for repeated prostate biopsies and that African American patients may merit increased frequency of PSA testing,” Dr Parson’s team wrote.
In an accompanying editorial, Yaw A. Nyame, MD, MS, MBA, and Michael P. Porter, MD, MS, of the University of Washington, Seattle, expressed a different opinion:
“It is unclear from this study why we should take a differential approach to the management of favorable-risk prostate cancer based on race and PSA velocity alone,” they wrote. “A Black man whose PSA increases from 5.0 to 5.44 ng/mL during the course of 1 year should not be considered unsuitable for continuation of active surveillance. Such a strategy may unduly increase this patient’s risk of overtreatment. It also highlights the importance of nuance in interpreting PSA parameters in active surveillance, which should also factor in absolute PSA values.”
At baseline, demographic factors such as age and comorbidity burden differed significantly between Black and White patients, which might have influenced results.
Nelson TJ, Javier-DesLoges J, Deka R, et al. Association of prostate-specific antigen velocity with clinical progression among African American and non-Hispanic White men treated for low-risk prostate cancer with active surveillance. JAMA Netw Open. Published online May 17, 2021. doi:10.1001/jamanetworkopen.2021.9452
Nyame YA, Porter MP. Prostate-specific antigen screening and active surveillance for high-risk individuals. JAMA Netw Open. Published online May 17, 2021. doi:10.1001/jamanetworkopen.2021.9711