Can We Predict Prostate Cancer Solely Based on PSA Velocity ?

An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection.

Vickers AJ, Till C, Tangen CM, Lilja H, Thompson IM.

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.

For more information, comments and full text article you should visit the source below

You could also check the Very Nice Prostate Cancer Risk Calculator here

Source:

http://www.ncbi.nlm.nih.gov/pubmed/21350221

About yuan ade sukma, MD

I'm an Indonesian doctor. I Believe that science and knowledge do not belong to anyone in the world. Science and knowledge is meant to be shared to make the world a better place to live. But if you find any material posted here is violating any copyrights, feel free to contact me and I will delete that. I believe that someday my blog can change the world. I BELIEVE in the POWER of WORDS! Do you..?
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4 Responses to Can We Predict Prostate Cancer Solely Based on PSA Velocity ?

  1. Pingback: PSA Velocity Shouldn’t be Used as Basis for Biopsy | Yuan Ade Sukma's Blog

  2. 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

  3. 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.

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