2043 PROSTATE-SPECIFIC ANTIGEN VELOCITY RISK COUNT IMPROVES THE SPECIFICITY OF SCREENING FOR CLINICALLY SIGNIFICANT PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Markers I1 Apr 20102043 PROSTATE-SPECIFIC ANTIGEN VELOCITY RISK COUNT IMPROVES THE SPECIFICITY OF SCREENING FOR CLINICALLY SIGNIFICANT PROSTATE CANCER Stacy Loeb, E. Jeffrey Metter, Donghui Kan, Kimberly Roehl, and William J. Catalona Stacy LoebStacy Loeb Baltimore, MD More articles by this author , E. Jeffrey MetterE. Jeffrey Metter Baltimore, MD More articles by this author , Donghui KanDonghui Kan Chicago, IL More articles by this author , Kimberly RoehlKimberly Roehl St. Louis, MO More articles by this author , and William J. CatalonaWilliam J. Catalona Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2090AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate-specific antigen (PSA)-based prostate cancer (CaP) screening has been shown to reduce CaP mortality at the expense of detecting some tumors that might never cause symptoms. PSA velocity (PSAV) has been shown to predict cancer-specific mortality after treatment. Our objective was to determine whether PSAV risk count (i.e. number of times PSAV exceeds a specific cutpoint) could increase the specificity of screening for biopsy-detectable CaP and potentially life-threatening tumors. METHODS From 1989 to 2001, we calculated 2 serial PSAV measurements in 18,214 CaP screening study participants, of whom 1125 (6.2%) were diagnosed with CaP. PSAV risk count was determined as the number of PSAV measurements >0.4 ng/ml/year (0, 1, or 2). We used receiver operating characteristic and net reclassification analyses to examine the ability of PSAV risk count to predict screen-detected CaP and high-grade CaP. RESULTS PSAV exceeded 0.4 ng/ml/year twice (risk count=2) in 40% of CaP cases compared to only 4% without cancer (p<0.0001). After adjusting for age and PSA, a PSAV risk count of 2 was associated with an 8.2-fold increased risk of CaP (95% CI, 7.0-9.6, p<0.0001) and 5.4-fold increased risk of Gleason score 8-10 CaP on biopsy. Compared to a model with age and PSA, the addition of PSAV risk count significantly improved discrimination (AUC 0.625 vs. 0.725, p=0.031, Figure 1) and reclassified individuals with respect to the risk of high-grade CaP (net reclassification, p<=0.0003). CONCLUSIONS Sustained rises in PSA indicate a significantly greater risk of CaP, particularly high-grade disease. Compared to men with a risk count <=1, those with two PSAV measurements >0.4 ng/ml/year (risk count=2) had an 8-fold increased risk of CaP and 5.4-fold increased risk of Gleason 8-10 disease on biopsy, adjusting for age and PSA. Compared to PSA alone, PSAV risk count may be useful to reduce unnecessary biopsies and the diagnosis of low-risk CaP. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLoeb S (2018) Editorial CommentJournal of Urology, VOL. 185, NO. 3, (826-827), Online publication date: 1-Mar-2011. Volume 183Issue 4SApril 2010Page: e793 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stacy Loeb Baltimore, MD More articles by this author E. Jeffrey Metter Baltimore, MD More articles by this author Donghui Kan Chicago, IL More articles by this author Kimberly Roehl St. Louis, MO More articles by this author William J. Catalona Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...