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Prostate-Specific Antigen Velocity for Early Detection of Prostate Cancer: Result from a Large, Representative, Population-based Cohort

Vickers, Andrew J.; Wolters, Tineke; Savage, Caroline J.; Cronin, Angel M.; O'Brien, M. Frank; Pettersson, Kim; Roobol, Monique J.; Aus, Gunnar; Scardino, Peter T. and Hugosson, Jonas, et al. (2009) In European Urology 56(5). p.753-760
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 Goteborg, 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 16... (More)
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 Goteborg, 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 16 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. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved. (Less)
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publication status
published
subject
keywords
Prostate-specific antigen, Prostate cancer, Prostate biopsy, Cancer detection, Predictive models, PSA velocity
in
European Urology
volume
56
issue
5
pages
753 - 760
publisher
Elsevier
external identifiers
  • wos:000271292500001
  • scopus:70349295163
ISSN
1873-7560
DOI
10.1016/j.eururo.2009.07.047
language
English
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yes
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bd280b5e-a85b-48ed-aa05-8fa5f396eaac (old id 1505098)
date added to LUP
2009-11-24 16:34:27
date last changed
2017-09-24 04:09:36
@article{bd280b5e-a85b-48ed-aa05-8fa5f396eaac,
  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 &lt; 3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer in Rotterdam, Netherlands, or Goteborg, 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 16 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 &gt;= 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. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.},
  author       = {Vickers, Andrew J. and Wolters, Tineke and Savage, Caroline J. and Cronin, Angel M. and O'Brien, M. Frank and Pettersson, Kim and Roobol, Monique J. and Aus, Gunnar and Scardino, Peter T. and Hugosson, Jonas and Schroder, Fritz H. and Lilja, Hans},
  issn         = {1873-7560},
  keyword      = {Prostate-specific antigen,Prostate cancer,Prostate biopsy,Cancer detection,Predictive models,PSA velocity},
  language     = {eng},
  number       = {5},
  pages        = {753--760},
  publisher    = {Elsevier},
  series       = {European Urology},
  title        = {Prostate-Specific Antigen Velocity for Early Detection of Prostate Cancer: Result from a Large, Representative, Population-based Cohort},
  url          = {http://dx.doi.org/10.1016/j.eururo.2009.07.047},
  volume       = {56},
  year         = {2009},
}