Don’t Use PSA Velocity as Basis for Biopsy
This is an interesting information from Dr Gerald Chodak from Medscape, regarding PSA velocity. He is the Director, Midwest Prostate and Urology Health Center, Michiana Shores, Indiana.
Hello. I am Dr. Gerald Chodak from Medscape. A recent article was published in the Journal of the National Cancer Institute by Vickers and coworkers that addressed an interesting question: whether the use of prostate-specific antigen (PSA) velocity added useful information in deciding which men should have a prostate biopsy.
Clearly, things have changed greatly since our understanding that no PSA level guarantees the absence of prostate cancer. However, using a dataset from the PCPT [Prostate Cancer Prevention Trial] Vickers and colleagues looked at the men who were in the placebo group. They represent an interesting group of men because all of them were undergoing a biopsy toward the end of the study regardless of whether they clearly had an indication on the basis of their PSA levels.
The investigators evaluated the data and found that the area under the curve that was generated by adding PSA velocity did not do a significantly better job than other methods, simply by using a cut point of 2.5 or 4 ng/mL. They evaluated different PSA velocities as indicated by recommendations made by the American Urological Association or the National Comprehensive Cancer Network guidelines, and none of the cut points or the PSA velocities used added significant useful information. This has very important implications because the investigators found that indeed, many men did undergo a biopsy without finding cancer, and the problem is that many men are getting unnecessary biopsies if PSA velocity is included in the definition.
The investigators make a very strong case for eliminating PSA velocity as one of the reasons to obtain a biopsy, particularly at low PSA levels (those in the 2.5-ng/mL and lower range). I think this is useful information.
It does have a limitation in that the men who were entered into the PCPT were all at least 55 years of age or older. It is quite possible that PSA velocity could add useful information with younger men, but that would require further investigation that is not covered by this study. The bottom line is that for the time being, the use of PSA velocity does not seem to provide a valid or reliable additive benefit in deciding who has prostate cancer.
The investigators do acknowledge that the ability to predict serious cancers with a PSA velocity of 2 ng/mL is important for identifying very high-risk cancers with long-term risk. However, that is not the question being decided here. The issue comes down to whether there is an added benefit to using PSA velocity in deciding who should have a prostate biopsy, and these data would argue that it does not add useful information.
I look forward to your comments. Thank you.
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