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Prostate-specific antigen velocity for early detection of prostate cancer: result from a large, representative, population-based cohort.

Abstract：

BACKGROUND:It has been suggested that changes in prostate-specific antigen (PSA) over time (ie, PSA velocity [PSAV]) aid prostate cancer detection. Some guidelines do incorporate PSAV cut points as an indication for biopsy. OBJECTIVE:To evaluate whether PSAV enhances prediction of biopsy outcome in a large, representative, population-based cohort. DESIGN, SETTING, AND PARTICIPANTS:There were 2742 screening-arm participants with PSA <3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer in Rotterdam, Netherlands, or Göteborg, Sweden, and who were subsequently biopsied during rounds 2-6 due to elevated PSA. MEASUREMENTS:Total, free, and intact PSA and human kallikrein 2 were measured for 1-6 screening rounds at intervals of 2 or 4 yr. We created logistic regression models to predict prostate cancer based on age and PSA, with or without free-to-total PSA ratio (%fPSA). PSAV was added to each model and any enhancement in predictive accuracy assessed by area under the curve (AUC). RESULTS AND LIMITATIONS:PSAV led to small enhancements in predictive accuracy (AUC of 0.569 vs 0.531; 0.626 vs 0.609 if %fPSA was included), although not for high-grade disease. The enhancement depended on modeling a nonlinear relationship between PSAV and cancer. There was no benefit if we excluded men with higher velocities, which were associated with lower risk. These results apply to men in a screening program with elevated PSA; men with prior negative biopsy were not evaluated in this study. CONCLUSIONS:In men with PSA of about ≥3 ng/ml, we found little justification for formal calculation of PSAV or for use of PSAV cut points to determine biopsy. Informal assessment of PSAV will likely aid clinical judgment, such as a sudden rise in PSA suggesting prostatitis, which could be further evaluated before biopsy.

journal_name

Eur Urol

journal_title

European urology

authors

Vickers AJ,Wolters T,Savage CJ,Cronin AM,O'Brien MF,Pettersson K,Roobol MJ,Aus G,Scardino PT,Hugosson J,Schröder FH,Lilja H

doi

10.1016/j.eururo.2009.07.047

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

753-60

issue

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(09)00795-7

journal_volume

pub_type

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Prostate-specific antigen velocity for early detection of prostate cancer: result from a large, representative, population-based cohort.