An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection Journal Article
| Authors: | Vickers, A. J.; Till, C.; Tangen, C. M.; Lilja, H.; Thompson, I. M. |
| Article Title: | An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection |
| Abstract: | Background The National Comprehensive Cancer Network and American Urological Association guidelines on early detection of prostate cancer recommend biopsy on the basis of high prostate-specific antigen (PSA) velocity, even in the absence of other indications such as an elevated PSA or a positive digital rectal exam (DRE). Methods To evaluate the current guideline, we compared the area under the curve of a multivariable model for prostate cancer including age, PSA, DRE, family history, and prior biopsy, with and without PSA velocity, in 5519 men undergoing biopsy, regardless of clinical indication, in the control arm of the Prostate Cancer Prevention Trial. We also evaluated the clinical implications of using PSA velocity cut points to determine biopsy in men with low PSA and negative DRE in terms of additional cancers found and unnecessary biopsies conducted. All statistical tests were two-sided. Results Incorporation of PSA velocity led to a very small increase in area under the curve from 0.702 to 0.709. Improvements in predictive accuracy were smaller for the endpoints of high-grade cancer (Gleason score of 7 or greater) and clinically significant cancer (Epstein criteria). Biopsying men with high PSA velocity but no other indication would lead to a large number of additional biopsies, with close to one in seven men being biopsied. PSA cut points with a comparable specificity to PSA velocity cut points had a higher sensitivity (23% vs 19%), particularly for high-grade (41% vs 25%) and clinically significant (32% vs 22%) disease. These findings were robust to the method of calculating PSA velocity. Conclusions We found no evidence to support the recommendation that men with high PSA velocity should be biopsied in the absence of other indications; this measure should not be included in practice guidelines. © 2011 The Author. Published by Oxford University Press. All rights reserved. |
| Keywords: | adult; controlled study; aged; middle aged; major clinical study; clinical trial; histopathology; placebo; united states; cancer diagnosis; diagnostic accuracy; sensitivity and specificity; prostate specific antigen; cancer prevention; tumor markers, biological; practice guideline; biopsy; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; disease severity; laboratory test; family history; prostate biopsy; clinical evaluation; practice guidelines as topic; finasteride; predictive value of tests; area under curve; multivariate analysis; early detection of cancer; predictive value; digital rectal examination; unnecessary procedures; diagnostic test accuracy study |
| Journal Title: | JNCI: Journal of the National Cancer Institute |
| Volume: | 103 |
| Issue: | 6 |
| ISSN: | 0027-8874 |
| Publisher: | Oxford University Press |
| Date Published: | 2011-03-16 |
| Start Page: | 462 |
| End Page: | 469 |
| Language: | English |
| DOI: | 10.1093/jnci/djr028 |
| PUBMED: | 21350221 |
| PROVIDER: | scopus |
| PMCID: | PMC3057983 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 23 June 2011" - "CODEN: JNCIA" - "Source: Scopus" |
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