title: Long-term prostate-specific antigen velocity in improved classification of prostate cancer risk and mortality.
abstract: BACKGROUND
  It remains unclear whether adding long-term prostate-specific antigen velocity (PSAV) to baseline PSA values improves classification of prostate cancer (PCa) risk and mortality in the general population.
  
  
  OBJECTIVE
  To determine whether long-term PSAV improves classification of PCa risk and mortality in the general population.
  
  
  METHODS
  We studied 503 men aged 30-80 yr, with and without PCa, who had repeated PSA measurements over 20 yr and up to 28 yr before PCa diagnosis. These were selected from among 7455 men in the Copenhagen City Heart Study, a prospective, general population study with follow-up from 1981 through 2010. Results were subsequently applied to all 1 351 441 men aged 40-80 yr living in Denmark from 1997 through 2006.
  
  
  METHODS
  PCa risk and mortality were assessed using Cox regression. Improvement in risk classification was assessed using the net reclassification index (NRI).
  
  
  RESULTS
  Age-adjusted hazard ratios for PCa risk and mortality were 2.7-5.3 and 2.3-3.4, respectively, for long-term PSAV when added to models already including baseline PSA values. For PCa risk and mortality, adding long-term PSAV to models already including baseline PSA values and age yielded continuous NRIs of 98-99% and 56-106%, respectively. Used on a nationwide scale (eg, for men aged 60-64 yr), long-term PSAV >0.35 versus ≤ 0.35 ng/ml per year appropriately reclassified 128 of 10 000 men with PCa and 8095 of 10 000 men with no PCa. Correspondingly, inappropriately reclassified were 49 of 10 000 men with PCa and 1658 of 10 000 men with no PCa.
  
  
  CONCLUSIONS
  Long-term PSAV in addition to baseline PSA value improves classification of PCa risk and mortality. Applying long-term PSAV nationwide, the ratio of appropriately to inappropriately classified men would typically be 5:1.
authors: Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Denmark.
authors: David D
authors: DD
authors: Ørsted
authors: Stig E
authors: SE
authors: Bojesen
authors: Pia R
authors: PR
authors: Kamstrup
authors: Børge G
authors: BG
authors: Nordestgaard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D006801:Humans; D007610:Kallikreins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Long-term PSA velocity; Prostate cancer incidence and mortality; Risk classification