An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection.
Feb 24th,2011
Source
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. vickersa@mskcc.org
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.
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You could also check the Very Nice Prostate Cancer Risk Calculator here
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Rather than looking at PSA velocity, physicians should rely on the collection of indicators already used to decide if a man needs a biopsy, including his PSA level, age, digital rectal exam and family history, Vickers tells the Health Blog. Adding PSA velocity to the mix increases the number of men who receive unnecessary biopsies without catching more cases of aggressive prostate cancer. You could also check the Very Nice Prostate Cancer Risk Calculator here
Annual checkups and tests for instance colonoscopies and PSA assays are very important, but it’s not recommended to rely on tests alone to protect you from cancer.
yes of course, test doesn’t protect you from cancer but many foods is proven to be effective protection from cancer https://yuanadesukma.wordpress.com/2011/05/19/10-top-causes-of-prostate-cancer-and-how-to-avoid-them/