title: Natural history of PSA increase with and without prostate cancer.
abstract: 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.
authors.affiliation: Department of Urology, Gunma University School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Ito
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Masaru
authors.initials: M
authors.lastname: Ohi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takechi
authors.forename: Kohei
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Yamanaka
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen