title: The utility of PSA velocity in prediction of prostate cancer and high grade cancer after an initially negative prostate biopsy.
abstract: BACKGROUND
  Prostate specific antigen kinetics (PSAK) including prostate specific antigen velocity (PSAV) and PSA doubling time (PSADT) are used as predictors of prostate cancer (PCa) therapeutic outcome, disease prognosis, and cancer-specific mortality. However controversy persists regarding use of these parameters in cancer detection. Our aim is to evaluate PSAV as a predictor of PCa and intermediate/high grade PCa (HGPCa).
  
  
  METHODS
  We included 682 patients that underwent repeat transrectal ultrasound guided biopsy after initial negative biopsy. Univariate and multivariate analyses as well as area under the receiver operating characteristic curve (ROC-AUC) were performed to assess predictive accuracy regarding detection of PCa and intermediate/HGPCa (Gleason score ≥ 7).
  
  
  RESULTS
  PCa was detected in 179/682 (26.24%) patients. Our univariate analysis suggested that age, total prostate volume (TPV), atypical small acinar proliferation (ASAP) and PSA indices in the form of PSA at the time of repeat biopsy (PSA2), PSAV, PSA density (PSAD2) and percent free PSA at time of repeat biopsy (%FPSA2) were all predictors of overall PCa and intermediate/HGPCa. Meanwhile, our multivariate model showed that factors associated with overall PCa and intermediate/HGPCa were age, PSAV and TPV.
  
  
  CONCLUSIONS
  In men pursuing a second biopsy after an initial negative biopsy, PSAV was an independent predictor of overall PCa, intermediate and high grade cancer.
authors.affiliation: Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elshafei
authors.forename: Yong-Hong
authors.initials: YH
authors.lastname: Li
authors.forename: Asmaa
authors.initials: A
authors.lastname: Hatem
authors.forename: Ayman S
authors.initials: AS
authors.lastname: Moussa
authors.forename: Vargo
authors.initials: V
authors.lastname: Ethan
authors.forename: Nirmal
authors.initials: N
authors.lastname: Krishnan
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: prostate biopsy; prostate specific antigen velocity; prostatic neoplasm