Prostate-Specific Antigen Velocity for Early Detection of Prostate Cancer: Result from a Large, Representative, Population-based Cohort Journal Article
| Authors: | Vickers, A. J.; Wolters, T.; Savage, C. J.; Cronin, A. M.; O'brien, M. F.; Pettersson, K.; Roobol, M. J.; Aus, G.; Scardino, P. T.; Hugosson, J.; Schroder, F. H.; Lilja, H. |
| Article Title: | 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. © 2009 European Association of Urology. |
| Keywords: | adult; aged; major clinical study; area under the curve; diagnostic accuracy; prostate specific antigen; cancer screening; prostate cancer; netherlands; sweden; prostate-specific antigen; prostate biopsy; kallikrein; prostatitis; cancer detection; predictive models; psa velocity |
| Journal Title: | European Urology |
| Volume: | 56 |
| Issue: | 5 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2009-11-01 |
| Start Page: | 753 |
| End Page: | 760 |
| Language: | English |
| DOI: | 10.1016/j.eururo.2009.07.047 |
| PROVIDER: | scopus |
| PMCID: | PMC2891354 |
| PUBMED: | 19682790 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 9" - "Export Date: 30 November 2010" - "CODEN: EUURA" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work