The utility of PSA velocity in prediction of prostate cancer and high grade cancer after an initially negative prostate biopsy

• Published in: The Prostate 2013-12, Vol.73 (16), p.1796-1802
• Main Authors: ElShafei, Ahmed, Li, Yong-Hong, Hatem, Asmaa, Moussa, Ayman S., Ethan, Vargo, Krishnan, Nirmal, Li, Jianbo, Jones, J. Stephen
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers, Tumor - metabolism; Biopsy; Humans; Male; Medical prognosis; Middle Aged; Mortality; Neoplasm Grading; Predictive Value of Tests; Prognosis; Prospective Studies; prostate biopsy; Prostate cancer; prostate specific antigen velocity; Prostate-Specific Antigen - metabolism; prostatic neoplasm; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retrospective Studies; Ultrasonography; Ultrasound, High-Intensity Focused, Transrectal - methods
• ISSN: 0270-4137; 1097-0045
• DOI: 10.1002/pros.22718

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. Prostate 73:1796–1802, 2013. © 2013 Wiley Periodicals, Inc.