title: Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening.
abstract: OBJECTIVE
  We identified age adjusted prostate specific antigen and prostate specific antigen velocity cut points for prostate cancer biopsy.
  
  
  METHODS
  A cohort of 33,643 men was retrieved from the Duke Prostate Center database. Of this group 11,861 men with 2 or more prostate specific antigen values within 2 years were analyzed for age adjusted prostate specific antigen and prostate specific antigen velocity performance in cancer risk assessment using a receiver operating characteristic curve.
  
  
  RESULTS
  In the 11,861 men prostate cancer prevalence was 273 (8.0%), 659 (14.9%) and 722 (17.9%) in the groups of men 50 to 59 years old, 60 to 69 and 70 years old or older. In prostate cancer groups median prostate specific antigen and prostate specific antigen velocity in men 50 to 59 vs 70 years old or older were 5.6 vs 8.1 ng/ml and 1.37 vs 1.89 ng/ml per year (<0.0001). In men 50 to 59 years old the sensitivity and specificity were 82.1% and 80.7% at prostate specific antigen 2.5 ng/ml, and 84.3% and 72.4% at prostate specific antigen velocity 0.40 ng/ml per year, higher than those in men 70 years old or older at prostate specific antigen 4.0 ng/ml or prostate specific antigen velocity 0.75 ng/ml per year. Decreasing the prostate specific antigen cut point to 2.0 ng/ml and the prostate specific antigen velocity cut point to 0.40 ng/ml per year in men 50 to 59 years old improved the cancer detection rate but decreased the positive predictive value.
  
  
  CONCLUSIONS
  Current biopsy guidelines (prostate specific antigen 4.0 ng/ml or greater, or prostate specific antigen velocity 0.75 ng/ml or greater per year) underestimated cancer risk in men 50 to 59 years old. Prostate specific antigen and prostate specific antigen velocity cut points should be age adjusted. In men 50 to 59 years old prostate specific antigen and prostate specific antigen velocity cut points could be decreased to 2.0 ng/ml and 0.40 ng/ml per year, respectively. Factors of age, sensitivity, specificity, positive predictive value and cancer prevalence are critical for obtaining the desired balance between cancer detection and negative biopsy.
authors.affiliation: Division of Urology and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina 27710, USA. Judd.moul@duke.edu
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: James M
authors.initials: JM
authors.lastname: Hotaling
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Fitzsimons
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Cary N
authors.initials: CN
authors.lastname: Robertson
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Anscher
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mouraviev
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pappas
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
mesh_terms: D000367:Age Factors; 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; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen