An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection
Vickers, Andrew J. ; Till, Cathee ; Tangen, Catherine M. ; Lilja, Hans LU
and Thompson, Ian M.
(2011)
In Journal of the National Cancer Institute
103(6).
p.462-469
- 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... (More)
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.
(Less)
- author
- Vickers, Andrew J.
; Till, Cathee
; Tangen, Catherine M.
; Lilja, Hans
LU
and Thompson, Ian M.
- publishing date
- 2011-03-16
- type
- Contribution to journal
- publication status
- published
- in
- Journal of the National Cancer Institute
- volume
- 103
- issue
- 6
- pages
- 462 - 469
- publisher
- Oxford University Press
- external identifiers
-
- scopus:79952833310
- pmid:21350221
- ISSN
- 0027-8874
- DOI
- 10.1093/jnci/djr028
- language
- English
- LU publication?
- no
- id
- fafbed73-fdd1-408f-9224-eaf1dded9183
- date added to LUP
- 2022-12-06 15:31:20
- date last changed
- 2024-06-13 23:14:02
@article{fafbed73-fdd1-408f-9224-eaf1dded9183,
abstract = {{<p>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.</p>}},
author = {{Vickers, Andrew J. and Till, Cathee and Tangen, Catherine M. and Lilja, Hans and Thompson, Ian M.}},
issn = {{0027-8874}},
language = {{eng}},
month = {{03}},
number = {{6}},
pages = {{462--469}},
publisher = {{Oxford University Press}},
series = {{Journal of the National Cancer Institute}},
title = {{An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection}},
url = {{http://dx.doi.org/10.1093/jnci/djr028}},
doi = {{10.1093/jnci/djr028}},
volume = {{103}},
year = {{2011}},
}