Older men are encouraged to get a prostate-specific antigen (PSA) blood test to screen for a protein that in some cases signals the presence of cancer. Yet no study has concluded definitely what a given PSA level means for survival and treatment. So there's confusion about whether to practice "watchful waiting" or to treat the disease and risk side effects or unnecessary surgery. Researchers from Brigham & Women's Hospital and colleagues at other institutions wanted to know whether tracking PSA levels in the year before diagnosis could predict the risk of death from prostate cancer.

What the researchers wanted to know: Can changes in PSA levels in the year prior to diagnosis predict death from prostate cancer after surgery to remove the prostate gland?

What they did: Researchers tracked the subsequent health of 1,095 men with localized prostate cancer who underwent a radical prostatectomy and also examined records of their PSA levels in the year before initial diagnosis.

What they found: "Men whose PSA level increases by more than 2.0 ng per milliliter during the year before the diagnosis of prostate cancer may have a relatively high risk of death from prostate cancer despite undergoing radical prostatectomy," the authors wrote.

What it means to you: Men whose PSA level rises more than 2.0 ng per milliliter ought to talk with their doctor about whether watchful waiting is best. The authors also urge men with a quickly rising PSA level to consider enrolling in a randomized clinical trial studying whether more aggressive treatment trumps waiting.

Caveats: While PSA levels are important, other clinical measures are also crucial determinants of survival. The exact relative risk facing men with rising PSA levels couldn't be determined by the investigators. Finally, it's still not clear exactly what to do if your PSA is rising quickly, since the study didn't explore whether prostatectomy produces different outcomes than does watchful waiting—hence the recommendation to enroll in a trial that will attempt to settle the question.

Find out more: http://www.cancer.gov/

Read the article: D'Amico, AV et al. Preoperative PSA Velocity and the Risk of Death from Prostate Cancer After Radical Prostatectomy. New England Journal of Medicine. July 8, 2004, Vol. 351, No. 2, pp. 125–135.