Use Of Prostate-specific Antigen Velocity Research Articles

Prostate-specific antigen velocity in diagnosis and prognosis of prostate cancer - a systematic review.

Prostate-specific antigen velocity (PSAV) is widely used to detect PC and predict its progression. In this study, we qualitatively synthesized the currently available evidence from published studies regarding the PSAV role in PC. Electronic databases were searched to find relevant articles published until January 2019. Inclusion and exclusion criteria were applied to identify related papers. Eventually, data extraction followed by evidence synthesis was conducted. Full-text screening resulted in 42 included studies. Multiple definitions and intervals were used for PSAV calculation across studies. Results from the included studies were conflicting regarding the role of PSAV in detecting PC and predicting progression in active surveillance cases. However, there is evidence that PSAV may have a predictive role in post-treated men. There is no clear-cut evidence from the published literature to support the use of PSAV in clinical practice.

Use of Prostate-Specific Antigen Velocity as a Screening Tool for Pre-Biopsy Detection of Prostate Cancer in African-American Men: A Single Institutional Analysis

Use of Prostate-Specific Antigen Velocity as a Screening Tool for Pre-Biopsy Detection of Prostate Cancer in African-American Men: A Single Institutional Analysis

The relationship between prostate volume and prostate‐specific antigen variability: data from the Baltimore Longitudinal Study of Aging and the Johns Hopkins Active Surveillance Program

Study Type--Prognostic (cohort). Level of Evidence 2b. What's known on the subject? And what does the study add? Previous studies have attempted to characterize the normal biological variability in PSA among men without prostate cancer. These reports suggest that PSA variability is unrelated to age, but there are conflicting data on its association with the baseline PSA level. There are limited published data regarding the effects of prostate volume on PSA variability. A prior study assessing whether prostate volume changes would confound the use of PSA velocity in clinical practice reported that prostate volume changes were not significantly related to PSA changes. This study did not directly address the effect of baseline prostate volume on serial PSA variability. The objective of the current study was to further examine the relationship between prostate volume and PSA variability. Our hypothesis was that larger baseline prostate volume would be associated with increased PSA variability in men without known prostate cancer and in those with suspected small-volume disease. The results of the study suggest that baseline PSA, not prostate volume, is the primary driver of PSA variability in these populations. • To clarify the relationship between serial prostate-specific antigen (PSA) variability and prostate volume in both cancer-free participants from the Baltimore Longitudinal Study of Aging (BLSA) and patients with low-risk prostate cancer from the Johns Hopkins Active Surveillance Program (AS). • In all, 287 men from the BLSA and 131 patients from the AS were included in the analysis, all with at least two PSA measurements and concurrent prostate volume measurements. • PSA variability was calculated in ng/mL per year, and a linear mixed-effects model was used to determine the relative effects of prostate volume, baseline PSA and age on PSA change over time. • In a model with prostate volume, age and baseline PSA, there was no significant relationship between prostate volume and PSA variability (BLSA, P= 0.57; AS, P= 0.49). • Only baseline PSA showed a significant relationship to PSA yearly variability (PSAYV) (P < 0.001). Specifically, a one unit higher baseline PSA (ng/mL) corresponded on average to 0.09 and 0.06 ng/mL per year higher PSAYV in the BLSA and AS populations, respectively. • The results of the present study suggest that the primary driver of PSA variability is the baseline PSA level, rather than prostate volume. • Clinicians might consider the baseline PSA level to help predict the expected variability in serial PSA measurements.

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.

Prostate-specific antigen (PSA) velocity: a test of controversial benefit in the era of increased prostate cancer screening

Prostate-specific antigen (PSA) velocity: a test of controversial benefit in the era of increased prostate cancer screening

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The Editorial Comment raises an important concern about confounding of prostate-specific antigen (PSA) kinetics from biological variability in the PSA measurement. Surprisingly, we found that this was less of an issue than expected. In our community-based population, only ∼1% of PSAV values exceeded 0.4 ng/mL/y in healthy men with PSA levels <3 ng/mL. Thus, if this cutpoint were used to determine the need for prostate biopsy at low PSA levels, few men would be subjected to unnecessary biopsy on the basis of PSA variability alone. Furthermore, a PSAV >0.4 ng/mL/y substantially increased the probability of life-threatening prostate cancer, suggesting that the use of PSAV in men with low total PSA levels should increase the specificity of screening for clinically important prostate cancer. However, as pointed out in the Editorial Comment, well-designed prospective studies are necessary to confirm this assertion. Editorial CommentUrologyVol. 77Issue 1PreviewStudies looking at prostate-specific antigen (PSA) kinetics have emerged in the last two decades with the intent to better discern which PSAs are actually associated with prostate cancer and, more importantly, aggressive disease. Carter et al from Johns Hopkins were the first to assess PSA velocity (PSAV) as a potential risk factor for development of prostate cancer using the Baltimore Longitudinal Study of Aging (BLSA).1 The authors looked at the serum levels of PSA taken 7-25 years before the development of “prostate disease” (benign prostatic hyperplasia [BPH] or prostate cancer) and concluded that a rate of change of 0.75 μg/L/y was significantly greater in subjects with prostate cancer compared with control subjects and subjects with BPH, and therefore “may be a sensitive and specific early clinical marker for the development of prostate cancer.” Full-Text PDF

Consequences of Switching 5α-Reductase Inhibitors on Prostate Specific Antigen Velocity

The 5alpha-reductase inhibitors improve urinary symptoms related to benign prostatic hyperplasia, deter benign prostatic hyperplasia progression and provide prostate cancer chemoprevention. Currently there are a number of 5alpha-reductase inhibitor formularies, including Proscar, generic finasteride and dutasteride. While all formularies decrease serum prostate specific antigen (a proxy for prostate volume), they may not accomplish this to the same degree, which may have dramatic effects on prostate specific antigen kinetics in men changing 5alpha-reductase inhibitor formularies. We examined prostate specific antigen velocity after changes in 5alpha-reductase inhibitor formularies. We identified patients treated with 2 or more 5alpha-reductase inhibitor formularies who had sufficient prostate specific antigen values to calculate prostate specific antigen velocity during each 5alpha-reductase inhibitor treatment. Patient data were grouped depending on the formularies received. Statistical analysis was done to compare prostate specific antigen velocity at various time points while on different 5alpha-reductase inhibitors. Eight men changed from dutasteride to generic finasteride (group 1), 21 changed from dutasteride to Proscar (group 2), 49 changed from Proscar to dutasteride (group 3) and 77 changed from Proscar to generic finasteride (group 4). We noted a significant increase in prostate specific antigen velocity in groups 1 and 2 (p <0.05), and 4 (p <0.005). The increase was greater than 0.35 ng/ml per year, the common cutoff for prostate biopsy recommendations, in more than a third of patients. Results confirm that changing 5alpha-reductase inhibitors drugs can be associated with a clinically significant change in prostate specific antigen velocity. These prostate specific antigen velocity changes could place patients at risk for unnecessary prostate biopsy. Additional prospective studies are warranted.

Prostate‐specific antigen velocity (PSAV): a practical role for PSA?

Prostate cancer is a leading cause of morbidity and mortality in Australian men. Early detection and treatment are critical to patient outcome, but detection is often difficult because of the limited accuracy of available tests. This paper assesses whether the use of prostate specific antigen kinetics has a practical use in the contemporary urological setting. A Medline literature review was performed examining related articles on the commonly available tests for prostate cancer, what they mean, their limited accuracy in cancer detection, and how this accuracy can be improved. Detection of significant organ-confined prostate cancer should be the goal of general practitioners and urologists alike. Prostate-specific antigen and digital rectal examination are commonly used but lack specificity and sensitivity, especially for small organ-confined cancers. The additional use of prostate-specific antigen velocity may enhance the specificity and sensitivity of detection.

Molecular biomarkers in prostate cancer

After more than two decades of clinical use, serum prostate-specific antigen (PSA) has increased the early diagnosis of prostate cancer, detecting the disease even when small volumes are present. Although stage migration of prostate cancer has occurred, PSA has well-known limitations, despite attempts at refinement and modification, such as the use of PSA velocity, which have been used to improve it. New biomarkers for prostate cancer have been discovered, with promising early results. This article reviews the ubiquitous current literature on biomarkers in prostate cancer. A search using MEDLINE and EMBASE databases was performed and those articles reporting biomarkers in prostate cancer with clinically significant findings in terms of detection were analyzed. Immunohistochemical markers were not considered for this review. Despite many markers being promising, no single marker has satisfied the criteria as a perfect candidate. Limited clinical use of IL-6, TGF-β1 and PCA3 has commenced, and further widespread availability of these tests is expected in the coming years. The future lies in artificial neural networks and panels of markers instead of individual assays. Although PSA has some well-known limitations, it is at present the best marker available for prostate cancer when used in conjunction with nomograms or risk calculators.

The use of prostate-specific antigen kinetics to stratify risk in prostate cancer

Risk assessment is critical to providing appropriate counseling and treatment for patients diagnosed with prostate cancer. The three classic clinical parameters to determine risk have been clinical stage, biopsy grade, and prostate-specific antigen (PSA) level. More recently, the importance of PSA kinetics has been realized in the pretreatment and serologic relapse settings. This article reviews the use of PSA velocity and PSA doubling time in several clinical scenarios.

Is Prostate-Specific Antigen Velocity Selective for Clinically Significant Prostate Cancer in Screening? European Randomized Study of Screening for Prostate Cancer (Rotterdam)

BackgroundThe value of prostate-specific antigen velocity (PSAV) in screening for prostate cancer (PCa) and especially for clinically significant PCa is unclear. ObjectiveTo assess the value of PSAV in screening for PCa. Specifically, the role of PSAV in lowering the number of unnecessary biopsies and reducing the detection rate of indolent PCa was evaluated. Design, Setting, and ParticipantsAll men included in the study cohort were participants in the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam section. InterventionDuring the first and second screening round, a PSA test was performed on 2217 men, and all underwent a biopsy during the second screening round 4 yr later. MeasurementsPSAV was calculated and biopsy outcome was classified as benign, possibly indolent PCa, or clinically significant PCa. Results and LimitationsA total of 441 cases of PCa were detected, 333 were classified as clinically significant and 108 as possibly indolent. The use of PSAV cut-offs reduced the number of biopsies but led to important numbers of missed (indolent and significant) PCa. PSAV was predictive for PCa (OR: 1.28, p<0.001) and specifically for significant PCa (OR: 1.46, p<0.001) in univariate analyses. However, multivariate analyses using age, PSA, prostate volume, digital rectal examination and transrectal ultrasonography outcome, and previous biopsy (yes/no) showed that PSAV was not an independent predictor of PCa (OR: 1.01, p=0.91) or significant PCa (OR: 0.87, p=0.30). ConclusionsThe use of PSAV as a biopsy indicator would miss a large number of clinically significant PCa cases with increasing PSAV cut-offs. In this study, PSAV was not an independent predictor of a positive biopsy in general or significant PCa on biopsy. Therefore, PSAV does not improve the ERSPC screening algorithm.

Use of Prostate-Specific Antigen Velocity to Follow Up Patients with Isolated High-Grade Prostatic Intraepithelial Neoplasia on Prostate Biopsy

No consensus has been reached about the optimal follow-up for patients with an isolated finding of high-grade prostatic intraepithelial neoplasia (HG-PIN) on prostate biopsy. Early studies reported that approximately one half of men with HG-PIN were diagnosed with prostate cancer (CaP) within a few years. However, more recent studies, using extended biopsy protocols, have shown that HG-PIN may be less predictive of CaP on repeat biopsy in the short term. Thus, our objective was to identify the clinical factors that could help predict which men with isolated HG-PIN were at the greatest risk of subsequent CaP detection. In 190 men from a CaP screening study with an initial biopsy finding of HG-PIN, we compared the prostate-specific antigen velocity (PSAV) between patients who were later diagnosed with CaP and those who were not. Multivariate models were constructed for the ability to predict CaP detection. The median PSAV was significantly greater in the men with HG-PIN who were subsequently diagnosed with CaP (P = 0.03). A PSAV threshold of 0.75 ng/mL/yr predicted which men with HG-PIN would ultimately be diagnosed with CaP (P = 0.007). On multivariate analysis, including PSAV, age, and initial PSA level, PSAV was the only significant predictor of subsequent CaP detection. Among the men with an isolated finding of HG-PIN on prostate needle biopsy, PSAV helps to identify those men who are subsequently diagnosed with CaP. Thus, we advocate the use of the PSAV to help guide the need for repeat biopsy in men with HG-PIN.

Controversies in Transrectal Ultrasonography and Prostate Biopsy

Transrectal ultrasound-guided biopsy of the prostate is the gold standard for the detection of prostate cancer. In its current form, transrectal gray-scale ultrasound is unable to differentiate malignant prostate tissue from benign tissue. The general indications for performing a sonographic guided biopsy of the prostate are an abnormal digital rectal examination or an abnormal prostate-specific antigen (PSA). Several controversial areas remain: the ideal number of biopsy cores, the use of PSA velocity, free PSA, PSA density, age- and race-adjusted PSA, the use of local anesthetics, and the overall best patient preparation methods, including such topics as routine antibiotic prophylaxis or bowel enemas, remain unsettled. There are also unanswered questions regarding repeat biopsy and protocols for managing patients with a diagnosis of high-grade intraepithelial neoplasia. This article will explore some of the current controversies and review the pertinent literature.

The role of prostate-specific antigen velocity in prostate cancer early detection

Prostate-specific antigen velocity (PSAV) is the rate of change in prostate-specific antigen (PSA) values with repeated measurement over time. Accurate use of PSAV for prostate cancer early detection requires the use of two or more PSA levels collected over approximately 1.5 to 2 years. When these specimen collection criteria are met, more than 95% of men without prostate cancer will have a PSAV less than 0.75 ng/mL/y, whereas approximately 70% of men with prostate cancer will have a PSAV above this threshold. PSAV is thus more specific than routine PSA testing for the presence of prostate cancer, because few men (< 5%) without prostate cancer have a PSAV sufficient to trigger prostate biopsy. The use of PSAV in the increasing number of men with lengthy PSA histories obtained in systematic efforts at prostate cancer early detection may aid in diagnosing prostate cancer and spare some men unnecessary prostate biopsy. This review briefly summarizes the theoretic basis and clinical utility of PSAV in prostate cancer early detection.