Prostate-specific Antigen Density Velocity Research Articles

Prostate Specific Antigen Density Velocity (PSADV) on Dutasteride Helps Predict Negative Prostate Biopsy: Analysis of the REDUCE Trial

AIM : Prostate specific antigen (PSA) is a widely utilized screening marker for prostate cancer. Its performance in detecting prostate cancer is enhanced with the 5α-reductase inhibitor (5aRI) dutasteride. We evaluated if PSA density velocity (PSADV) further improved the ability to predict prostate cancer risk on repeat biopsy utilizing the REDUCE trial data in order to avoid unnecessary biopsies. MATERIALS AND METHODS : The REDUCE study randomized 8 231 men aged 50 to 75 years with a PSA between 2.5 and 10 ng/mL and a previously benign prostate biopsy. Prostate volume, PSA and biopsy results at 24 months were available for 1 074 subjects. PSADV, defined as the change in PSA density divided by the number of days between PSA measurements (ng/mL/cc/day), was calculated and compared between the placebo and treatment groups and further stratified by prostate biopsy results. Statistical significance was calculated using the Wilcoxon rank sum test. RESULTS : Median PSA, PSA velocity, and PSADV are shown for the placebo and dutasteride treatment cohorts at 24 months in Table 1. Median PSA velocity in both the placebo and treatment groups were positive independent of a prostate cancer diagnosis. Results of PSADV stratified by treatment and biopsy results are seen in the boxplots in Figure 1. There was a significantly more robust reduction in PSADV in those without cancer on biopsy compared to those with prostate cancer in the treatment arm (P = 0.0019). CONCLUSIONS : The magnitude of change in PSADV after dutasteride therapy may be an additional diagnostic adjunct to aid in the identification of those at lower risk for prostate cancer on repeat biopsy. This measurement may reduce unnecessary prostate biopsies and the increasingly prevalent associated risks of the procedure.

1943 PROSTATE SPECIFIC ANTIGEN DENSITY VELOCITY ON DUTASTERIDE HELPS PREDICT NEGATIVE PROSTATE BIOPSY: ANALYSIS OF THE REDUCE TRIAL

AIM: Prostate specific antigen (PSA) is a widely utilized screening marker for prostate cancer. Its performance in detecting prostate cancer is enhanced with the 5α-reductase inhibitor (5aRI) dutasteride. We evaluated if PSA density velocity (PSADV) further improved the ability to predict prostate cancer risk on repeat biopsy utilizing the REDUCE trial data in order to avoid unnecessary biopsies. MATERIALS AND METHODS: The REDUCE study randomized 8 231 men aged 50 to 75 years with a PSA between 2.5 and 10 ng/ mL and a previously benign prostate biopsy. Prostate volume, PSA and biopsy results at 24 months were available for 1 074 subjects. PSADV, defined as the change in PSA density divided by the number of days between PSA measurements (ng/mL/cc/day), was calculated and compared between the placebo and treatment groups and further stratified by prostate biopsy results. Statistical significance was after prostate cancer diagnosis or final biopsy) PSADV, defined as the change in PSA density divided by the number of days between PSA measurements (ng/ml/cc/day), was calculated and compared between the placebo and treatment groups and further stratified by prostate biopsy results. Statistical significance was calculated using the Wilcoxon rank sum test performed at the significance level of 0.05.

Prostate Specific Antigen Velocity per Prostate Volume: A Novel Tool for Prostate Biopsy Prediction

To investigate whether altered prostate specific antigen (PSA) levels due to individual prostate growth may affect the PSA velocity (PSAV). Between January 2000 and December 2009, a total of 159 men with at least 2 transrectal ultrasonography (TRUS) procedures and concurrent PSA measurements underwent prostate biopsy because of suspicion of prostate cancer. We measured PSAV, prostate volume velocity (PVV), PSA density (PSAD), PSAD velocity (PSADV), and PSAV per initial volume. We then classified the total group into a prostate cancer (PC) group and non-PC group, and compared the 2 groups. We investigated which variables were exact to predict prostate biopsy using univariate and multivariate analyses, and assessed the diagnostic performance using the receiver operating characteristic (ROC) curve. PVV showed a positive correlation with initial prostate volume in the total and non-PC group; PVV showed a positive correlation with PSAV, and initial prostate volume correlated with PSAV in the non-PC group. The PC group showed smaller prostate volumes, higher PSAD, higher PSADV, higher PSAV per initial volume, and longer follow-up periods. After adjusting for confounding factors, the odds ratios of prostate cancer across the quartile of PSAVD were 1, 1.889, 3.226, and 7.125 (P for trend = .007), and PSAV per initial volume were 1, 2.924, 2.937, and 7.536 (P for trend = .031). On the ROC curve, the areas under the curves (AUC) of PSAV per initial volume were higher than for PSAV and PSADV. Altered PSA levels due to individual prostate growth may affect the use of PSAV to predict prostate biopsy outcomes in follow-up.