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Prostate Specific Antigen Velocity Threshold for Predicting Prostate Cancer in Young Men

Thursday, 22 March 2007

BERKELEY, CA (UroToday.com) - Traditionally, a prostate biopsy has been recommended for patients with a PSA velocity of 0.75 ng/ml per year due to its increased association with prostate cancer. The relationship between PSA velocity and prostate cancer in young men has not been extensively studied.

In the March issue of the Journal of Urology, Loeb and colleagues from Georgetown, Northwestern, and Washington University report the results of a cohort of 6,844 men age 60 years or younger who enrolled in a prospective prostate cancer screening study. The overall prostate cancer detection rate for the cohort was 5%. Various thresholds of PSA velocity were evaluated to determine the highest predictive value for prostate cancer.

A PSA velocity threshold of 0.4 ng/ml per year or greater was independently predictive of cancer irrespective of age, total PSA, family history of prostate cancer, or race. What was most dramatic was that this criterion had the strongest association to cancer in multivariate analysis, even in patients with a total PSA less than 2.5 ng/ml. Using a PSA velocity threshold of 0.4 ng/ml/year was found to have a sensitivity of 67%, specificity of 81%, positive predictive value of 16%, and negative predictive value of 98%.

This study suggests that using a PSA velocity biopsy threshold of 0.75 ng/ml/year for men younger than 60 years may be inappropriate. Using a PSA velocity of 0.4 ng/ml/year or greater may enhance prostate cancer early detection especially in men with a total PSA lower than 2.5 ng/ml.

Loeb S, Roehl KA, Catalona WJ, Nadler RB

J Urol. 2007 Mar; 177(3):899-902

UroToday.com Prostate Cancer Section

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