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Prostate Specific Antigen Velocity in Men With Total Prostate Specific Antigen Less Than 4 ng/ml

2007; Lippincott Williams & Wilkins; Volume: 178; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2007.08.016

1527-3792

Stacy Loeb, Kimberly A. Roehl, Robert B. Nadler, Xiaoying Yu, William J. Catàlona,

Urologic and reproductive health conditions

No AccessJournal of UrologyAdult urology1 Dec 2007Prostate Specific Antigen Velocity in Men With Total Prostate Specific Antigen Less Than 4 ng/ml Stacy Loeb, Kimberly A. Roehl, Robert B. Nadler, Xiaoying Yu, and William J. Catalona Stacy LoebStacy Loeb Department of Urology, the James Buchanan Brady Urological Institute, the Johns Hopkins Medical Institutions, Baltimore, Maryland Nothing to disclose. More articles by this author , Kimberly A. RoehlKimberly A. Roehl Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri Nothing to disclose. More articles by this author , Robert B. NadlerRobert B. Nadler Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois Financial interest and/or other relationship with Boston Scientific Corp. More articles by this author , Xiaoying YuXiaoying Yu Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois Nothing to disclose. More articles by this author , and William J. CatalonaWilliam J. Catalona Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois Financial interest and/or other relationship with Beckman Coulter Incorporated. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.08.016AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A prostate specific antigen velocity threshold of 0.75 ng/ml per year has commonly been used to distinguish men with prostate cancer from those with benign prostate conditions. In addition, a prostate specific antigen velocity greater than 2 ng/ml per year has been linked to an increased prostate cancer specific mortality rate after radical prostatectomy and after radiation therapy. However, both of these frequently cited thresholds were determined largely in groups of men with a prostate specific antigen greater than 4 ng/ml. Materials and Methods: Of approximately 26,000 men who participated in a prostate cancer screening study 22,019 had a prostate specific antigen of 4 ng/ml or less. Of these men 501 were diagnosed with prostate cancer and had sufficient data for a prostate specific antigen velocity calculation. We performed univariate and multivariate analyses to compare cancer detection rates and performance characteristics using various prostate specific antigen velocity thresholds in these men. Results: In men with a prostate specific antigen less than 4 ng/ml, a prostate specific antigen velocity threshold of 0.4 ng/ml per year was most useful for recommending prostate biopsy. Overall prostate cancer was diagnosed in 223 (2%) men with a prostate specific antigen velocity less than 0.4 ng/ml per year compared to 278 (13%) men with a prostate specific antigen velocity greater than 0.4 ng/ml per year (p <0.0001). On multivariate analysis a prostate specific antigen velocity greater than 0.4 ng/ml per year was a stronger independent predictor of prostate cancer diagnosis than age, race or a family history of prostate cancer. Conclusions: The traditional prostate specific antigen threshold of 0.75 ng/ml per year was determined largely in men with a total prostate specific antigen of 4 to 10 ng/ml. Prostate specific antigen velocity thresholds in the range of 0.4 ng/ml per year should be used to help guide the need for biopsy in men with a total prostate specific antigen less than 4 ng/ml. References 1 : Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA1992; 267: 2215. Crossref, Medline, Google Scholar 2 : Rate of change in serum prostate specific antigen levels as a method for prostate cancer detection. J Urol1994; 152: 1163. Abstract, Google Scholar 3 : Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med2004; 351: 125. Google Scholar 4 : Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy. JAMA2005; 294: 440. Google Scholar 5 : Prediagnosis prostate specific antigen velocity is associated with risk of prostate cancer progression following brachytherapy and external beam radiation therapy. J Urol2006; 176: 1399. Link, Google Scholar 6 : Preoperative PSA velocity is an independent prognostic factor for relapse after radical prostatectomy. J Clin Oncol2005; 23: 6157. Google Scholar 7 : Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old. Urology2006; 67: 316. Google Scholar 8 : Prostate specific antigen velocity threshold for predicting prostate cancer in young men. J Urol2007; 177: 899. Link, Google Scholar 9 : Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening. J Urol2007; 177: 499. Link, Google Scholar 10 : The association between total prostate specific antigen concentration and prostate specific antigen velocity. J Urol2007; 177: 1298. Link, Google Scholar 11 : The nature of prostate cancer detected through prostate specific antigen based screening. J Urol1994; 152: 1732. Link, Google Scholar 12 : Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst2006; 98: 1521. Google Scholar 13 : Low levels of prostate-specific antigen predict long-term risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging. Urology2001; 58: 411. Google Scholar 14 : Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men. J Urol2000; 163: 1144. Link, Google Scholar 15 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection. http://www.nccn.org/professionals/physician_gls/PDF/prostate_detection.pdf. Accessed December 17, 2006. Google Scholar 16 : Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med2004; 350: 2239. Google Scholar © 2007 by American Urological AssociationFiguresReferencesRelatedDetailsCited byLoeb S, Roehl K, Helfand B, Kan D and Catalona W (2009) Can Prostate Specific Antigen Velocity Thresholds Decrease Insignificant Prostate Cancer Detection?Journal of Urology, VOL. 183, NO. 1, (112-117), Online publication date: 1-Jan-2010.Loeb S, Chan D, Sokoll L, Kan D, Maggiore J, Mikolajczyk S, Mondo D, Griffin C and Catalona W (2008) Prostate Specific Antigen Assay Standardization Bias Could Affect Clinical Decision MakingJournal of Urology, VOL. 180, NO. 5, (1959-1963), Online publication date: 1-Nov-2008. Volume 178Issue 6December 2007Page: 2348-2353 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordsprostate-specific antigenmass screeningprostatic neoplasmsMetricsAuthor Information Stacy Loeb Department of Urology, the James Buchanan Brady Urological Institute, the Johns Hopkins Medical Institutions, Baltimore, Maryland Nothing to disclose. More articles by this author Kimberly A. Roehl Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri Nothing to disclose. More articles by this author Robert B. Nadler Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois Financial interest and/or other relationship with Boston Scientific Corp. More articles by this author Xiaoying Yu Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois Nothing to disclose. More articles by this author William J. Catalona Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois Financial interest and/or other relationship with Beckman Coulter Incorporated. More articles by this author Expand All Advertisement PDF downloadLoading ...