Long-term prediction of prostate cancer: Prostate-specific antigen (PSA) velocity is predictive but does not improve the predictive accuracy of a single PSA measurement 15 years or more before cancer diagnosis in a large, representative, unscreened population Journal Article


Authors: Ulmert, D.; Serio, A. M.; O'brien, M. F.; Becker, C.; Eastham, J. A.; Scardino, P. T.; Björk, T.; Berglund, G.; Vickers, A. J.; Lilja, H.
Article Title: Long-term prediction of prostate cancer: Prostate-specific antigen (PSA) velocity is predictive but does not improve the predictive accuracy of a single PSA measurement 15 years or more before cancer diagnosis in a large, representative, unscreened population
Abstract: Purpose: We tested whether total prostate-specific antigen velocity (tPSAv) improves accuracy of a model using PSA level to predict long-term risk of prostate cancer diagnosis. Methods: During 1974 to 1986 in a preventive medicine study in Sweden, 5,722 men aged ≤ 50 gave two blood samples about 6 years apart. We measured free (fPSA) and total PSA (tPSA) in archived plasma samples from 4,907 participants. Prostate cancer was subsequently diagnosed in 443 (9%) men. Cox proportional hazards regression was used to evaluate tPSA and tPSAv as predictors of prostate cancer. Predictive accuracy was assessed by the concordance index. Results: The median time from second blood draw to cancer diagnosis was 16 years; median follow-up for men without prostate cancer was 21 years. In univariate models, tPSA level at second assessment and tPSAv between first and second assessments were associated with prostate cancer (both P < .001). tPSAv was highly correlated with tPSA level (r = 0.93). Twenty-year probabilities of cancer for men at 50th, 90th, and 95th percentile of tPSA and tPSAv were 10.6%, 17.1%, and 21.2% for tPSA, and 9.1%, 11.8%, and 14.1% for tPSAv, respectively. The concordance index for tPSA level was 0.771. Adding tPSAv, fPSA, %fPSA or velocities of fPSA and %fPSA did not importantly increase accuracy of tPSA to predict prostate cancer. Results were unchanged if the analysis was restricted to patients with advanced cancer at diagnosis. Conclusion: Although PSA velocity is significantly increased in men with prostate cancer up to two decades before diagnosis, it does not aid long-term prediction of prostate cancer. © 2008 by American Society of Clinical Oncology.
Keywords: controlled study; major clinical study; comparative study; research design; follow up; methodology; cancer diagnosis; diagnostic accuracy; biological marker; prostate specific antigen; accuracy; proportional hazards models; incidence; tumor markers, biological; cancer screening; tumor marker; time; time factors; prostate cancer; sweden; prostate-specific antigen; prostatic neoplasms; blood; immunology; proportional hazards model; blood sampling; prostate tumor; measurement; prediction and forecasting; predictive value of tests; regression analysis
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 6
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-02-20
Start Page: 835
End Page: 841
Language: English
DOI: 10.1200/jco.2007.13.1490
PUBMED: 18281654
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 38" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Peter T Scardino
    621 Scardino
  2. Hans Gosta Lilja
    286 Lilja
  3. Andrew J Vickers
    565 Vickers
  4. Matthew Francis O'Brien
    20 O'Brien
  5. Angel M Cronin
    145 Cronin
  6. James Eastham
    427 Eastham