Prostate specific antigen velocity does not aid prostate cancer detection in men with prior negative biopsy.
OBJECTIVE
Prostate specific antigen velocity has been proposed as a marker to aid in prostate cancer detection. We determined whether prostate specific antigen velocity could predict repeat biopsy results in men with persistently increased prostate specific antigen after initial negative biopsy.


METHODS
We identified 1,837 men who participated in the Göteborg or Rotterdam section of the European Randomized Screening study of Prostate Cancer and who underwent 1 or more subsequent prostate biopsies after an initial negative finding. We evaluated whether prostate specific antigen velocity improved predictive accuracy beyond that of prostate specific antigen alone.


RESULTS
Of the 2,579 repeat biopsies 363 (14%) were positive for prostate cancer, of which 44 (1.7%) were high grade (Gleason score 7 or greater). Prostate specific antigen velocity was statistically associated with cancer risk but had low predictive accuracy (AUC 0.55, p <0.001). There was some evidence that prostate specific antigen velocity improved AUC compared to prostate specific antigen for high grade cancer. However, the small increase in risk associated with high prostate specific antigen velocity (from 1.7% to 2.8% as velocity increased from 0 to 1 ng/ml per year) had questionable clinical relevance.


CONCLUSIONS
Men with prior negative biopsy are at lower risk for prostate cancer at subsequent biopsies with high grade disease particularly rare. We found little evidence to support prostate specific antigen velocity to aid in decisions about repeat biopsy for prostate cancer.
Vickers
Andrew J
AJ
Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. vickersa@mskcc.org
Wolters
Tineke
T
Savage
Caroline J
CJ
Cronin
Angel M
AM
O'Brien
M Frank
MF
Roobol
Monique J
MJ
Aus
Gunnar
G
Scardino
Peter T
PT
Hugosson
Jonas
J
Schröder
Fritz H
FH
Lilja
Hans
H
D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*; D013997:Time Factors
D017430:Prostate-Specific Antigen