title: Prostate-specific antigen 'velocity' as a diagnostic test for prostate cancer.
abstract: BACKGROUND
  Prostate-specific antigen "velocity" (slope) is promoted as a diagnostic test for prostate cancer, but its clinical usefulness is uncertain. Accordingly, we evaluated the sensitivity of prostate-specific antigen (PSA) velocity among men who are diagnosed subsequently with prostate cancer.
  
  
  METHODS
  Among 64,545 men receiving primary care at any of nine Veterans Affairs Medical Centers during 1989-1990, 1,313 men at least 50 years old had an incident diagnosis of prostate cancer during 1991-1995. PSA velocity values obtained prior to diagnosis ("test") were compared with results from prostate biopsies ("truth").
  
  
  RESULTS
  Among men (n = 493) with at least two tests before diagnosis, the sensitivity of PSA velocity > or = 0.75 ng/mL/yr was 75.5% (95% confidence interval [CI] 71.7-79.3) overall and 48.1% (95% CI 34.8-61.5) among men with normal values of PSA (< 4.0 ng/mL). Based on published data for specificity and prevalence, the estimated positive predictive value of PSA velocity > or = 0.75 ng/mL/yr is as low as 5%.
  
  
  CONCLUSIONS
  PSA velocity may have limited usefulness as a diagnostic test for prostate cancer.
authors.affiliation: Department of Medicine, Clinical Epidemiology Research Center, VA Connecticut Healthcare System, New Haven 06516, USA. john.concato@yale.edu
authors.forename: John
authors.initials: J
authors.lastname: Concato
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Wells
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen