Response: Re: Detection of Life-Threatening Prostate Cancer With Prostate-Specific Antigen Velocity During a Window of Curability

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Abstract
Our recommendation that prostate-specific antigen velocity (PSAV) be part of a decision algorithm for prostate biopsy referral is based on observations that include a current approach to prostate-specific antigen testing that has resulted in the serendipitous discovery of many cancers that otherwise would have remained undetected ( 1 ). The standard approach to biopsy referral based on an absolute PSA threshold has resulted in no treatment benefit for the majority of those men who are diagnosed with prostate cancer today. A recent population-based study ( 2 ) reveals that 200 older men with low to intermediate risk prostate cancer (>80% of prostate cancers detected today) need to be treated to prevent one prostate cancer death for 12 years. We predict that in the United States we will soon be labeling one in five men over a lifetime with prostate cancer if the trend of lowering PSA thresholds for biopsy referral and increasing the amount of tissue removed at biopsy continue ( 3 ). Thus, we need an alternative approach for biopsy referral that more effectively targets life-threatening disease.