Prebiopsy PSA Velocity Not Reliable Predictor of Prostate Cancer Diagnosis, Gleason Score, Tumor Location, or Cancer Volume After TTMB

• Published in: Urology (Ridgewood, N.J.) N.J.), 2009-07, Vol.74 (1), p.171-176
• Main Authors: Bittner, Nathan, Merrick, Gregory S, Andreini, Hugo, Taubenslag, Walter, Allen, Zachariah A, Butler, Wayne M, Anderson, Richard L, Adamovich, Edward, Wallner, Kent E
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biopsy, Needle - methods; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Predictive Value of Tests; Preoperative Care; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.12.013

Objectives To evaluate the effect of prostate-specific antigen (PSA) velocity (PSAV) on prostate cancer diagnosis, Gleason score, tumor location, and cancer volume in men undergoing transperineal template-guided mapping biopsy (TTMB). PSAV has been associated with greater Gleason scores and greater prostate cancer-specific mortality. Methods From January 2005 through September 2007, 217 patients underwent TTMB. The inclusion criteria included a persistently elevated PSA level and/or diagnosis of atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia on previous biopsy. The prostate gland was arbitrarily divided into 24 regions, and a median of 58 cores were obtained per patient. The patients were divided into 3 velocity cohorts according to the following changes in PSA level in the year before biopsy: ≤0.0, 0.1-1.9, and ≥2.0 ng/mL. The PSAV was evaluated as a predictor for prostate cancer diagnosis, Gleason score, tumor volume, and cancer location. Results The mean patient age was 64.2 years, with a mean prebiopsy PSA level of 8.5 ng/mL. Prostate cancer was diagnosed in 97 patients (44.7%). The study population had undergone an average of 1.8 ± 1.0 biopsies before TTMB. PSAV did not predict for prostate cancer diagnosis ( P = .84), Gleason score ( P = .78), the percentage of positive cores ( P = .37), or tumor location. Conclusions Among patients with persistently elevated PSA levels despite previously negative biopsy findings, PSAV did not reliably predict for a diagnosis of prostate cancer nor did it correlate with prostate cancer grade, volume, or location using TTMB.