Does prostate-specific antigen velocity help in early detection prostate cancer?

Nov 05, 2009

The November issue of European Urology, the official journal of the European Association of Urology, features an article focussing on prostate specific antigen (PSA) velocity and early cancer detection. It has been suggested that changes in PSA over time aid prostate cancer detection.

It is argued that a rapidly rising PSA may indicate a greater risk of diagnosis of prostate even if are low. Some guidelines do incorporate PSA velocity cut points as an indication for biopsy. Professor A.J. Vickers of the Memorial Sloan-Kettering Cancer Center, Department of Medicine in New York (US): "Thus our aim was to evaluate whether PSA velocity indeed enhances the prediction of biopsy outcome in a large, representative, population-based cohort."

There were 2742 screening-arm participants with PSA <3 ng/ml at initial screening in the european randomized study of screening for prostate cancer (erspc) in rotterdam (nl) or göteborg (se) who were subsequently biopsied due to elevated psa.

Professor Vickers: "Our study has several strengths. It included a very large number of men in a randomized trial, who were therefore subject to highly standardized testing and follow-up procedures. We avoided verification bias and addressed the key question of whether PSA velocity adds information beyond that provided by PSA alone. We also used decision analysis to examine the clinical impact of decisions based on PSA velocity".

The conclusion of the study is that PSA velocity adds very little predictive value for determining the outcome of a first prostate biopsy in men with elevated PSA. These findings are very similar to those of earlier studies. "Accordingly, we see little justification for formal calculation of PSA velocity and subsequent incorporation into a , and no justification for velocity cut points, in determining indication for biopsy. This suggests that current guidelines on the use of PSAV to guide biopsy should be revised. However, we encourage use of clinical judgment in decisions about biopsy: A sudden rise in PSA might suggest prostatitis, triggering further evaluation of symptoms, laboratory tests, or empirical . If evidence of prostatitis is absent, a might well be advisable. This type of sophisticated, sequential, clinical decision making cannot easily be evaluated in analyses of population-based screening studies", says Professor Vickers.

More information: Velocity for Early Detection of : Result from a Large, Representative, Population-based Cohort, Andrew J. Vickers, Tineke Wolters, Caroline J. Savage, Angel M. Cronin, M. Frank O'Brien, Kim Pettersson, Monique J. Roobol, Gunnar Aus, Peter T. Scardino, Jonas Hugosson, Fritz H. Schröder, Hans Lilja, European Urology, Volume 56, issue 5, pages 753-890, November 2009

Source: European Association of Urology

Explore further: Immunotherapy could stop resistance to radiotherapy

add to favorites email to friend print save as pdf

Related Stories

Prostate cancer gene test provides new early detection

Oct 16, 2008

Prostate cancer (PCa) is one of the most common male cancers in the Western world. Currently, early detection of PCa depends on an abnormal digital rectal examination and an elevated prostate-specific-antigen (PSA) level ...

High pretreatment PSA velocity predicts worse outcome

May 25, 2007

The most significant single predictor of aggressive prostate cancer is an elevated rate of increase in prostate specific antigen (PSA) levels, according to a new study. Published in the July 1, 2007 issue of CANCER, a peer-reviewed ...

PSA screening cuts deaths by 20 percent

Mar 18, 2009

Screening for prostate cancer can reduce deaths by 20%, according to the results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) published online 1700 hours CET, today 18 March (NEJM, Online First*). ...

Recommended for you

Americans undergo colonoscopies too often, study finds

16 hours ago

Colonoscopies are a very valuable procedure by which to screen for the presence of colorectal cancer. However, it seems that healthy Americans who do undergo this sometimes uncomfortable examination often ...

User comments : 0