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Prostate Specific Antigen Velocity Risk Count Predicts Biopsy Reclassification for Men with Very Low Risk Prostate Cancer

2013; Lippincott Williams & Wilkins; Volume: 191; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2013.09.029

1527-3792

Hiten D. Patel, Zhaoyong Feng, Patricia Landis, Bruce J. Trock, Jonathan I. Epstein, H. Ballentine Carter,

Urologic and reproductive health conditions

No AccessJournal of UrologyAdult Urology1 Mar 2014Prostate Specific Antigen Velocity Risk Count Predicts Biopsy Reclassification for Men with Very Low Risk Prostate Cancer Hiten D. Patel, Zhaoyong Feng, Patricia Landis, Bruce J. Trock, Jonathan I. Epstein, and H. Ballentine Carter Hiten D. PatelHiten D. Patel , Zhaoyong FengZhaoyong Feng , Patricia LandisPatricia Landis , Bruce J. TrockBruce J. Trock , Jonathan I. EpsteinJonathan I. Epstein , and H. Ballentine CarterH. Ballentine Carter View All Author Informationhttps://doi.org/10.1016/j.juro.2013.09.029AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prostate specific antigen velocity is an unreliable predictor of adverse pathology findings in patients on active surveillance for low risk prostate cancer. However, to our knowledge a new concept called prostate specific antigen velocity risk count, recently validated in a screening cohort, has not been investigated in an active surveillance cohort. Materials and Methods: We evaluated a cohort of men from 1995 to 2012 with prostate cancer on active surveillance. They had stage T1c disease, prostate specific antigen density less than 0.15 ng/ml, Gleason score 6 or less, 2 or fewer biopsy cores and 50% or less involvement of any core with cancer. The men were observed by semiannual prostate specific antigen measurements, digital rectal examinations and an annual surveillance biopsy. Treatment was recommended for biopsy reclassification. Patients with 30 months or greater of followup and 3 serial prostate specific antigen velocity measurements were used in primary analysis by logistic regression, Cox proportional hazards, Kaplan-Meier analysis and performance parameters, including the AUC of the ROC curve. Results: Primary analysis included 275 of 668 men who met very low risk inclusion criteria, of whom 83 (30.2%) were reclassified at a median of 57.1 months. Reclassification risk increased with risk count, that is a risk count of 3 (HR 4.63, 95% CI 1.54–13.87) and 2 (HR 3.73, 95% CI 1.75–7.97) compared to zero. Results were similar for Gleason score reclassification (HR 7.45, 95% CI 1.60–34.71 and 3.96, 95% CI 1.35–11.62, respectively). On secondary analysis the negative predictive value (risk count 1 or less) was 91.5% for reclassification in the next year. Adding the prostate specific antigen velocity risk count improved the AUC in a model including baseline prostate specific antigen density (0.7423 vs 0.6818, p = 0.025) and it outperformed the addition of overall prostate specific antigen velocity (0.7423 vs 0.6960, p = 0.037). 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Volume 191Issue 3March 2014Page: 629-637Supplementary Materials Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsriskprostatic neoplasmsbiopsyprostate-specific antigenprostateMetricsAuthor Information Hiten D. Patel More articles by this author Zhaoyong Feng More articles by this author Patricia Landis More articles by this author Bruce J. Trock More articles by this author Jonathan I. Epstein More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement PDF downloadLoading ...