Natural history of PSA increase with and without prostate cancer.
OBJECTIVE
To investigate the natural history of prostate-specific antigen (PSA) increase in men with and without prostate cancer to clarify the probability of cancer-related PSA increase.


METHODS
Between 1986 and 2001, 504 men aged 79 years or younger with baseline PSA levels of 4.0 ng/mL or less and a PSA increase greater than 4.0 ng/mL on consecutive screening were enrolled in this study. The types of PSA increase were classified as "non-cancer-related PSA increase," "suspicious cancer-related PSA increase," and "cancer-related PSA increase." The probability of a "cancer-related PSA increase" was investigated and stratified by baseline PSA levels and elapsed years until the PSA level increased to greater than 4.0 ng/mL.


RESULTS
The probability of a "non-cancer-related increase," "suspicious cancer-related PSA increase," and "cancer-related PSA increase" was 57%, 15%, and 28%, respectively. The PSA velocity before the PSA increase was not significantly different between those with and without prostate cancer. A "non-cancer-related PSA increase" was observed in 92% of those with a PSA increase within 2 years of baseline PSA ranges of 2.0 ng/mL or less. Regardless of elapsed years until a PSA increase to greater than 4.0 ng/mL, a "suspicious cancer-related PSA increase" or "cancer-related PSA increase" was observed in almost one half of those with baseline PSA levels of 2.1 to 4.0 ng/mL.


CONCLUSIONS
Intensive serial observations should be recommended before undergoing biopsy for those with a PSA increase within 2 years of a baseline PSA range of 0.0 to 2.0 ng/mL. It may be difficult to distinguish between those with and without cancer using only subsequent total PSA measurements for the remaining cases, and prostate biopsy should be recommended at present.
Ito
Kazuto
K
Department of Urology, Gunma University School of Medicine, Maebashi, Gunma, Japan.
Yamamoto
Takumi
T
Ohi
Masaru
M
Takechi
Hiroyuki
H
Kurokawa
Kohei
K
Suzuki
Kazuhiro
K
Yamanaka
Hidetoshi
H
D000230:Adenocarcinoma / Q000097:blood* / Q000473:pathology; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001707:Biopsy, Needle; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000175:diagnosis / Q000473:pathology; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen