PSA Velocity Does not Improve Prostate Cancer Detection

One of the major issues for men who are being screened for prostate cancer is whether or not to undergo a prostate needle biopsy. Factors considered in the standard risk model include prostate-specific antigen (PSA) level, digital rectal examination result, age, family history of prostate cancer and history of any prior prostate biopsies. The rate of change in PSA levels with time, referred to as PSA velocity, has also been used as one criterion for determining the need for a prostate biopsy. Clinical recommendations from two organizations, the National Comprehensive Cancer Network (NCCN) and the American Urology Association (AUA), suggest that men with a PSA velocity that exceeds a certain threshold value (0.35 ng/ml per year) should consider having a needle biopsy, even if their overall PSA levels are below the standard cutoff for the procedure and they have a normal result on a digital rectal examination. However, a recent study published online February 24 in the Journal of the National Cancer Institute concluded that a rapid increase in prostate-specific antigen (PSA) levels is not grounds for automatically recommending a prostate biopsy. This study was also summarized in the March 8th, 2011 issue of the National Cancer Institute (NCI) Cancer Bulletin. Researchers looked at whether a PSA velocity above the 0.35 ng/ml per year threshold—when added to a standard risk model that includes age, PSA level, DRE result, family history of prostate cancer, and history of a prior prostate biopsy—improved the model’s predictive accuracy. The authors concluded that “in all cases, the addition of PSA velocity yielded only a slight difference in the risk model’s predictive accuracy. In fact, the analysis indicated that lowering the PSA threshold for a biopsy from 4.0 ng/ml to 2.5 ng/ml would be a more effective means of directing prostate biopsies.”

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