Prostate-specific antigen velocity and the odds of detecting gleason 8 to 10 prostate cancer at biopsy

Abstract

4567 Background: Increased detection of high-grade prostate cancer was observed in the Prostate Cancer Prevention Trial (PCPT) in men receiving finasteride that halves prostate-specific antigen (PSA) and eliminates subsequent PSA rise from benign prostatic hyperplasia. Therefore despite doubling PSA, men receiving finasteride needed a larger PSA rise to exceed 4 ng/ml and have prostate biopsy recommended compared to placebo. We evaluated whether the PSA rise during the year before biopsy (PSA velocity) was associated with prostate cancer detection. Methods: Between 1/90 and 12/03, of 2125 prostate biopsies performed for a PSA exceeding 4 ng/ml or a nodule on digital rectal examination (DRE), prostate cancer was identified in 1418. Multivariable logistic regression analyses were performed evaluating the detection of Gleason 6 or less, 7, or 8 to 10 cancer. Covariates included the continuous variables of PSA velocity and level, number of prior negative biopsies and age and the categorical variables of ethnicity, DRE findings and family history. Results: As shown in the table , PSA velocity was only associated with Gleason 8 to 10 cancers (Adjusted Odds Ratio: 1.05 [95% Confidence Interval: 1.02 to 1.08]; p = 0.001). Age, PSA level and DRE status were associated across Gleason scores (p-values 0.005 or less), whereas family history (p-values 0.02 or less) and number of prior negative biopsies (p-values 0.01 or less) were associated with Gleason 7 or less cancers. Conclusion: PSA velocity is associated with Gleason 8 to 10 cancers at biopsy providing rationale for the PCPT results and a tool to enhance detection of clinically significant prostate cancer. [Table: see text] No significant financial relationships to disclose.