Prostate-specific antigen velocity and the detection of gleason score 7 to 10 prostate cancer.
BACKGROUND
An increasing prostate-specific antigen (PSA) velocity is associated with a shorter survival after local therapy for prostate cancer. In this study, the authors evaluated whether PSA velocity was associated with prostate cancer detection and grade at diagnosis after adjusting for established predictors.


METHODS
Between January 1989 and December 2003, 914 men who had PSA levels >/=4 ng/mL were identified by using the Center for Prostate Disease Research (CPDR) multicenter national database, including 541 men who were diagnosed with prostate cancer. Multivariable logistic regression analyses were performed that included continuous variables (PSA velocity and level, number of prior negative biopsies, and age) along with categorical variables (ethnicity and family history) were used to identify the factors associated with prostate cancer detection and grade.


RESULTS
An increasing PSA velocity was associated with Gleason scores from 7 to 10 versus Gleason scores form 2 to 6 or no cancer (adjusted odds ratio [OR], 1.04 ng/mL per year; 95% confidence interval [95% CI], 1.003-1.085 ng/mL per year; P = .035). This finding was not evident in patients who had prostate cancers with Gleason scores between 2 and 6 or for any prostate cancer. PSA level was associated with the detection of any prostate cancer (OR, 1.06 ng/mL; 95% CI, 1.03-1.10 ng/mL; P = .004) and Gleason score </=6 prostate cancer (OR, 1.06 ng/mL; 95% CI, 1.02-1.10 ng/mL; P = .0027); however, in the presence of PSA velocity, PSA no longer remained independently predictive for high-grade prostate cancer (OR, 1.01 ng/mL; 95% CI, 0.98-1.04 ng/mL; P = .45) after adjusting for established predictors.


CONCLUSIONS
PSA velocity enhanced the detection of high-grade cancer in men who had PSA levels >4 ng/mL. These findings, in conjunction with life expectancy, may be used when deciding which men should not be recommended for prostate biopsy despite a PSA level >4 ng/mL.
Punglia
Rinaa S
RS
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. rpunglia@partners.org
Cullen
Jennifer
J
McLeod
David G
DG
Chen
Yongmei
Y
D'Amico
Anthony V
AV
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen