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PSA velocity screening for prostate cancer may lead to unnecessary biopsies
Date:2/24/2011

Guidelines of several cancer organizations have recommended that men with a rapid rise in PSA have a biopsy for prostate cancer, even if there is no other indication and the PSA is within the "normal" range. But change in PSA known as PSA velocityis a poor predictor of prostate cancer, and may lead to many unnecessary biopsies, according to a study published online February 24 in the Journal of the National Cancer Institute.

Researchers have known for many years that PSA velocity is statistically correlated with prostate cancer risk. But little is known about how much PSA velocity adds to the value of other indicators or how useful it is to men and their physicians in making decisions about biopsies. And there has never been a study of PSA velocity in men who have had biopsies in the absence of a high PSA or a positive digital rectal exam.

Andrew Vickers, Ph.D., at Memorial Sloan-Kettering Cancer Center, and colleagues assessed how well PSA velocity predicted cancer (positive biopsy results) in 5,519 men who took part in the Prostate Cancer Prevention Trial. The men in this analysis were all in the group that received a placebo, so their prostate cancer risk was not influenced by the drug finasteride (Proscar), which was tested in that trial. All had a biopsy at the end of the study, regardless of their PSA levels, PSA velocity, or other indicators.

As expected, the authors found a statistical association between PSA velocity and biopsy outcome. But when they adjusted for other risk indicators, such as age, race, PSA levels, and digital rectal exam, there was virtually no association between PSA velocity and biopsy outcome.

"There was little evidence that PSA velocity adds an important level of predictive accuracy to either standard predictors or to PSA alone," they write.

The authors also evaluated guidelines stating that men with a rapid rise in PSA should have a biopsy even if their PSA is low and th
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Contact: Caroline McNeil
Caroline.McNeil@oup.com
301-841-1286
Journal of the National Cancer Institute
Source:Eurekalert

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