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Does prostate-specific antigen velocity help in early detection prostate cancer?
November 06, 2009The November issue of European Urology, the official journal of the European Association of Urology, features an article focussing on prostate specific antigen (PSA) velocity and early cancer detection. It has been suggested that changes in PSA over time aid prostate cancer detection.
It is argued that a rapidly rising PSA may indicate a greater risk of diagnosis of prostate cancer even if PSA levels are low. Some guidelines do incorporate PSA velocity cut points as an indication for biopsy. Professor A.J. Vickers of the Memorial Sloan-Kettering Cancer Center, Department of Medicine in New York (US): "Thus our aim was to evaluate whether PSA velocity indeed enhances the prediction of biopsy outcome in a large, representative, population-based cohort."
There were 2742 screening-arm participants with PSA <3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer (ERSPC) in Rotterdam (NL) or Göteborg (SE) who were subsequently biopsied due to elevated PSA.
Professor Vickers: "Our study has several strengths. It included a very large number of men in a randomized trial, who were therefore subject to highly standardized testing and follow-up procedures. We avoided verification bias and addressed the key question of whether PSA velocity adds information beyond that provided by PSA alone. We also used decision analysis to examine the clinical impact of decisions based on PSA velocity".
The conclusion of the study is that PSA velocity adds very little predictive value for determining the outcome of a first prostate biopsy in men with elevated PSA. These findings are very similar to those of earlier studies. "Accordingly, we see little justification for formal calculation of PSA velocity and subsequent incorporation into a statistical model, and no justification for velocity cut points, in determining indication for biopsy. This suggests that current guidelines on the use of PSAV to guide biopsy should be revised. However, we encourage use of clinical judgment in decisions about biopsy: A sudden rise in PSA might suggest prostatitis, triggering further evaluation of symptoms, laboratory tests, or empirical antibiotic therapy. If evidence of prostatitis is absent, a biopsy might well be advisable. This type of sophisticated, sequential, clinical decision making cannot easily be evaluated in analyses of population-based screening studies", says Professor Vickers.
European Association of Urology
Professor Vickers: "Our study has several strengths. It included a very large number of men in a randomized trial, who were therefore subject to highly standardized testing and follow-up procedures. We avoided verification bias and addressed the key question of whether PSA velocity adds information beyond that provided by PSA alone. We also used decision analysis to examine the clinical impact of decisions based on PSA velocity".
The conclusion of the study is that PSA velocity adds very little predictive value for determining the outcome of a first prostate biopsy in men with elevated PSA. These findings are very similar to those of earlier studies. "Accordingly, we see little justification for formal calculation of PSA velocity and subsequent incorporation into a statistical model, and no justification for velocity cut points, in determining indication for biopsy. This suggests that current guidelines on the use of PSAV to guide biopsy should be revised. However, we encourage use of clinical judgment in decisions about biopsy: A sudden rise in PSA might suggest prostatitis, triggering further evaluation of symptoms, laboratory tests, or empirical antibiotic therapy. If evidence of prostatitis is absent, a biopsy might well be advisable. This type of sophisticated, sequential, clinical decision making cannot easily be evaluated in analyses of population-based screening studies", says Professor Vickers.
European Association of Urology
Prostate Cancer Current Events and Prostate Cancer News RSSCommon pain relief medication may encourage cancer growth
Although morphine has been the gold-standard treatment for postoperative and chronic cancer pain for two centuries, a growing body of evidence is showing that opiate-based painkillers can stimulate the growth and spread of cancer cells.
Young athletes need dual screening tests for heart defects, study suggests
To best detect early signs of life-threatening heart defects in young athletes, screening programs should include both popular diagnostic tests, not just one of them, according to new research from heart experts at Johns Hopkins.
Routine evaluation of prostate size not as effective in cancer screening, Mayo study finds
New Mayo Clinic research studied the association between prostate-specific antigen (PSA) levels and prostate size and found that routine annual evaluation of prostate growth is not necessarily a predictor for the development of prostate cancer.
Carnegie Mellon researchers link health-care debate to risk of dying in US and Europe
The current health care debate in the United States is complicated. Trade-offs between heath care expenditures, lifestyle choices and life expectancy have been suggested but seldom clearly demonstrated.
New finding suggests prostate biopsy is not always necessary
Researchers at Wake Forest University School of Medicine and the University of Wisconsin-Madison have discovered that some elevated prostate-specific antigen (PSA) levels in men may be caused by a hormone normally occurring in the body, and are not necessarily a predictor of the need for a prostate biopsy.
New Synthetic Molecules Trigger Immune Response to HIV and Prostate Cancer
Researchers at Yale University have developed synthetic molecules capable of enhancing the body's immune response to HIV and HIV-infected cells, as well as to prostate cancer cells. Their findings, published online in the Journal of the American Chemical Society, could lead to novel therapeutic approaches for these diseases.
Chemo-radiation before prostate removal may prevent cancer recurrence
Researchers in the Oregon Health & Science University Knight Cancer Institute and the Portland Veterans Affairs Medical Center have found a combination of radiation therapy and chemotherapy given before prostate removal is safe and may have the potential to reduce cancer recurrence and improve patient survival.
Blood vessels might predict prostate cancer behavior
A diagnosis of prostate cancer raises the question for patients and their physicians as to how the tumor will behave. Will it grow quickly and aggressively and require continuous treatment, or slowly, allowing therapy and its risks to be safely delayed?
Short-term hormone therapy and intermediate dose radiation increases survivial for early stage prostate cancer
Short-term hormone therapy given prior to and during intermediate dose radiation treatment for men with early stage prostate cancer increases their chance of living longer, compared to those who receive the same radiation alone.
Task force develops new radiation guidelines for brachytherapy
Radiation dose delivered to the prostate and nearby organs in every brachytherapy procedure should be carefully analyzed using post-implant CT or MRI and uniformly documented in every patient.
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