Two studies have examined whether additional testing and screening techniques will be valuable for stratifying patients at greater risk of developing life-threatening prostate cancer or cervical abnormalities.

H. Ballentine Carter and colleagues showed that a high prostate-specific antigen (PSA) velocity (rate of change) seen prior to prostate cancer diagnosis might help identify men at a greater risk of developing life-threatening disease. The authors examined samples taken from 980 men; 856 without prostate cancer, 104 with prostate cancer (who were either alive or who subsequently died of another cause) and 20 who subsequently died from prostate cancer. PSA velocity measured 10–15 years before diagnosis was shown to be associated with cancer-specific survival 25 years later. Men who had a low PSA velocity (≤0.35 ng ml−1per year) had a significantly higher level of survival (92%) compared with those who had a PSA velocity >0.35 ng ml−1per year (54% overall survival). Similar observations were made for relative risk of prostate cancer death. Although PSA velocity might be able to identify men at a higher risk of death from prostate cancer at a stage when they have more curable disease, the study had several limitations, including a relatively small sample size with prostate cancer, and no comparison of the value of PSA velocity versus PSA levels. Ongoing large randomized trials should help more definitively address the value of PSA velocity for prostate cancer prognosis.

Susanne Kjaer and colleagues found that women who had normal cervical cytologies, as judged by a Pap smear test, but who tested positive for human papillomavirus (HPV) DNA, were at a greater risk of developing high-grade cervical intraepithelial neoplasia (CIN) than women with negative HPV tests. The authors examined 8,656 women aged 22–32 years and 1,578 women aged 40–50 years. A large proportion of both groups (24.5% of older and 17.7% of younger women) with positive HPV tests went on to have an abnormal Pap smear within 5 years, compared with about 5% of those with negative HPV tests. In the older women who had positive tests for high-risk HPV, the risk of developing CIN grade 3 (CIN3) or cervical cancer within 10 years was 21.2%, substantially higher than the 1.7% risk for women with negative HPV tests. In the younger women with positive HPV tests, the risk of CIN3 or cancer within 10 years was 13.6%, compared with 3.1% in those who had negative HPV tests. The authors conclude that even a single positive HPV test is substantially predictive, and might help stratify risk.