title: Prostate-specific antigen velocity (PSAV) risk count improves the specificity of screening for clinically significant prostate cancer.
abstract: OBJECTIVE
  •  To determine whether the prostate-specific antigen velocity (PSAV) risk count (i.e. the number of times PSAV exceeds a specific threshold) could increase the specificity of screening for prostate cancer and potentially life-threatening tumours.
  
  
  METHODS
  •  From 1989 to 2001, we calculated two serial PSAV measurements in 18 214 prostate cancer screening-study participants, of whom 1125 (6.2%) were diagnosed with prostate cancer. •  The PSAV risk count was determined as the number of PSAV measurements of >0.4 ng/mL/year (0, 1, or 2). •  We used receiver operating characteristic (ROC) and reclassification analyses to examine the ability of PSAV risk count to predict screen-detected and high-grade prostate cancer.
  
  
  RESULTS
  •  The PSAV was >0.4 ng/mL/year twice (risk count 2) in 40% of prostate cancer cases compared with only 4% of those with no cancer (P < 0.001). •  After adjusting for age and PSA level, a PSAV risk count of 2 was associated with an 8.2-fold increased risk of prostate cancer (95% confidence interval 7.0-9.6, P < 0.001) and 5.4-fold increased risk of Gleason score 8-10 prostate cancer on biopsy. •  Compared with a model with age and PSA level, the addition of the PSAV risk count significantly improved discrimination (area under the ROC curve 0.625 vs 0.725, P= 0.031) and reclassified individuals for the risk of high-grade prostate cancer (net reclassification, P < 0.001).
  
  
  CONCLUSIONS
  •  Sustained rises in PSA indicate a significantly greater risk of prostate cancer, particularly high-grade disease. •  Compared with men with a risk count of ≤1, those with two PSAV measurements of >0.4 ng/mL/year (risk count 2) had an 8-fold increased risk of prostate cancer and 5.4-fold increased risk of Gleason 8-10 disease on biopsy, adjusting for age and PSA level. •  Compared to PSA alone, PSAV risk count may be useful in reducing unnecessary biopsies and the diagnosis of low-risk prostate cancer.
authors.affiliation: Department of Urology, New York University School of Medicine, New York, NY, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.forename: E Jeffrey
authors.initials: EJ
authors.lastname: Metter
authors.forename: Donghui
authors.initials: D
authors.lastname: Kan
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.forename: William J
authors.initials: WJ
authors.lastname: Catalona
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen