Prostate specific antigen velocity per prostate volume: a novel tool for prostate biopsy prediction.
ABSTRACT To investigate whether altered prostate specific antigen (PSA) levels due to individual prostate growth may affect the PSA velocity (PSAV).
Between January 2000 and December 2009, a total of 159 men with at least 2 transrectal ultrasonography (TRUS) procedures and concurrent PSA measurements underwent prostate biopsy because of suspicion of prostate cancer. We measured PSAV, prostate volume velocity (PVV), PSA density (PSAD), PSAD velocity (PSADV), and PSAV per initial volume. We then classified the total group into a prostate cancer (PC) group and non-PC group, and compared the 2 groups. We investigated which variables were exact to predict prostate biopsy using univariate and multivariate analyses, and assessed the diagnostic performance using the receiver operating characteristic (ROC) curve.
PVV showed a positive correlation with initial prostate volume in the total and non-PC group; PVV showed a positive correlation with PSAV, and initial prostate volume correlated with PSAV in the non-PC group. The PC group showed smaller prostate volumes, higher PSAD, higher PSADV, higher PSAV per initial volume, and longer follow-up periods. After adjusting for confounding factors, the odds ratios of prostate cancer across the quartile of PSAVD were 1, 1.889, 3.226, and 7.125 (P for trend = .007), and PSAV per initial volume were 1, 2.924, 2.937, and 7.536 (P for trend = .031). On the ROC curve, the areas under the curves (AUC) of PSAV per initial volume were higher than for PSAV and PSADV.
Altered PSA levels due to individual prostate growth may affect the use of PSAV to predict prostate biopsy outcomes in follow-up.
- SourceAvailable from: Wim J Kirkels[show abstract] [hide abstract]
ABSTRACT: Parameters of prostate volume and shape were determined in a community based population of 502 men 55 to 74 years old who had not undergone a previous prostate operation and did not suffer from prostatic cancer. The volumes of the total prostate and of the central relatively hypoechoic area of the prostate were determined. Of all men in this age range 95% had a total prostate volume of more than 20 cm3. Moderate correlations between age and both volume measurements were found (r = 0.26, p < 0.0001 and r = 0.34, p < 0.0001, respectively). The percentage increase per year of central hypoechoic volume (3.5%) was higher than that of total prostatic volume (2%). The average doubling time of total prostatic volume and volume of the central hypoechoic prostate was calculated to be 35 and 20 years, respectively. The roundness of the prostate as expressed by width-to-height ratio at the largest transverse section of the prostate correlated poorly with age (r = -0.13, p = 0.004). The average total prostate volumes as measured by transrectal ultrasound were 21 to 28% higher than reported average volumes measured at autopsy in men in the same age range.The Journal of Urology 11/1994; 152(5 Pt 1):1501-5. · 3.70 Impact Factor
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ABSTRACT: To examine prospectively the usefulness of measurement of rate of change in serum prostate specific antigen levels (PSA slope) in detecting prostate cancer in a PSA-based prostate cancer screening study, we evaluated 982 serially screened men whose initial screening was negative for cancer. All men had at least 1 PSA value greater than 4.0 ng./ml. and all ultimately underwent prostatic biopsy. For those who entered the study with normal PSA levels, a PSA slope cutoff point of 0.75 ng./ml. per year or more maximized sensitivity and specificity for predicting cancer (odds ratio 7.20, 95% confidence interval 4.52 to 11.47). This cutoff point was most predictive for men 70 years old or younger. For men who entered the study with elevated PSA levels (greater than 4.0 ng./ml.) a lower PSA slope cutoff point (0.4 ng./ml. per year or more) maximized sensitivity and specificity for predicting cancer (odds ratio 2.73, 95% confidence interval 1.82 to 4.07). We conclude that PSA slope is useful for serial prostate cancer screening, although its predictive value varies with patient age and initial PSA level.The Journal of Urology 11/1994; 152(4):1163-7. · 3.70 Impact Factor
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ABSTRACT: To determine whether the use of the free-to-total PSA ratio (percent free PSA) could increase the specificity of PSA testing for prostate cancer detection in men with serum PSA concentrations between 4.0 and 10.0 ng/mL, and to assess the influence of total PSA, prostate volume, and age on percent free PSA. Sera were obtained from 217 men with histologically confirmed diagnoses (139 prostate cancer, 78 benign). Free and total PSA concentrations were determined using Hybritech Tandem assays. Use of percent free PSA increased PSA specificity: 29% of negative biopsies would be spared while retaining 95% sensitivity. Percent free PSA increased with increasing age and prostate volume. Percent free PSA decreased as total PSA increased. A significant relation exists between percent free PSA and the probability of a positive biopsy; in this cohort, a patient with a low percent free PSA (< or = 10%) had a higher probability of cancer (63 +/- 9%) than a patient with a high percent free PSA (> or = 26%) (probability 2 +/- 3%). Percent free PSA may be used as an aid in distinguishing prostate cancer from benign disease in men with a total PSA between 4.0 and 10.0 ng/mL. Large prospective multicenter trials are required to develop consistent recommendations and determine the appropriate cutpoints and risk probabilities, controlling for total PSA, prostate volume, age, and biopsy history.Urology 01/1997; 48(6A Suppl):55-61. · 2.42 Impact Factor