An examination of the dynamic changes in prostate-specific antigen occurring in a population-based cohort of men over time.
OBJECTIVE
• To determine whether prostate-specific antigen velocity (PSA-V), PSA doubling time (PSA-DT), or PSA percentage change (PSA-PC) add incremental information to PSA alone for community-based men undergoing prostate cancer (PCa) screening.


METHODS
• A population-based cohort of 11 872 men from Olmsted County, MN undergoing PSA screening for PCa from 1993 to 2005 was analysed for PSA, PSA-DT, PSA-PC and PSA-V and subsequent PCa. • Receiver-operating characteristics curves and logistic regression were used to calculate the area under the curve (AUC) and Aikaike's information criterion. • Reclassification analysis was performed and the net reclassification improvement and integrated discrimination improvement were measured. • The method of Begg and Greenes was used to adjust for verification bias.


RESULTS
• The single best predictor of future PCa was PSA (AUC = 0.773) with PSA-V (AUC = 0.729) and PSA-DT/PSA-PC (AUC = 0.689) performing worse. • After age adjustment, combining PSA with PSA-V (AUC = 0.773) or PSA-DT/PSA-PC (AUC = 0.773) resulted in no better predictions than PSA alone. • Reclassification analysis showed that adding PSA-V or PSA-DT/PSA-PC to PSA did not result in a meaningful amount of reclassification.


CONCLUSIONS
• PSA is a better predictor of future PCa than PSA-V, PSA-DT, or PSA-PC. • Adding PSA-V, PSA-DT, or PSA-PC to PSA does not result in clinically relevant improvements in the ability to predict future PCa.
Division of Urology, Duke University Medical Center, Durham, NC 27710, USA. brant.inman@duke.edu
Brant A
BA
Inman
Jingyu
J
Zhang
Nilay D
ND
Shah
Brian T
BT
Denton
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen