However, more recent studies have put in doubt the true role of PSA velocity, the European Randomized Study of Screening for Prostate Cancer demonstrated that increased PSA velocity was not associated with increased cancer risk, but was associated with higher grade cancers, defined as ≥ stage T1c and/or a Gleason score ≥7 (Roobol, 2006a). Age and race adjusted PSA values has also been called in question, evaluating whether or not the PSA age adjusted range is sufficient to eliminate the need for a biopsy, revealed that 54% of patients who would not be biopsied using these criteria, had a high grade cancer diagnosed (Wolff, 2000). Similarly the free-PSA.
