title: Is prostate-specific antigen velocity selective for clinically significant prostate cancer in screening? European Randomized Study of Screening for Prostate Cancer (Rotterdam).
abstract: BACKGROUND
  The value of prostate-specific antigen velocity (PSAV) in screening for prostate cancer (PCa) and especially for clinically significant PCa is unclear.
  
  
  OBJECTIVE
  To assess the value of PSAV in screening for PCa. Specifically, the role of PSAV in lowering the number of unnecessary biopsies and reducing the detection rate of indolent PCa was evaluated.
  
  
  METHODS
  All men included in the study cohort were participants in the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam section.
  
  
  METHODS
  During the first and second screening round, a PSA test was performed on 2217 men, and all underwent a biopsy during the second screening round 4 yr later.
  
  
  METHODS
  PSAV was calculated and biopsy outcome was classified as benign, possibly indolent PCa, or clinically significant PCa.
  
  
  CONCLUSIONS
  A total of 441 cases of PCa were detected, 333 were classified as clinically significant and 108 as possibly indolent. The use of PSAV cut-offs reduced the number of biopsies but led to important numbers of missed (indolent and significant) PCa. PSAV was predictive for PCa (OR: 1.28, p<0.001) and specifically for significant PCa (OR: 1.46, p<0.001) in univariate analyses. However, multivariate analyses using age, PSA, prostate volume, digital rectal examination and transrectal ultrasonography outcome, and previous biopsy (yes/no) showed that PSAV was not an independent predictor of PCa (OR: 1.01, p=0.91) or significant PCa (OR: 0.87, p=0.30).
  
  
  CONCLUSIONS
  The use of PSAV as a biopsy indicator would miss a large number of clinically significant PCa cases with increasing PSAV cut-offs. In this study, PSAV was not an independent predictor of a positive biopsy in general or significant PCa on biopsy. Therefore, PSAV does not improve the ERSPC screening algorithm.
authors: Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. t.wolters@erasmusmc.nl
authors: Tineke
authors: T
authors: Wolters
authors: Monique J
authors: MJ
authors: Roobol
authors: Chris H
authors: CH
authors: Bangma
authors: Fritz H
authors: FH
authors: Schröder
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001706:Biopsy; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011467:Prostate / Q000033:anatomy & histology / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000401:mortality; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen