Rise in PSA Levels Poor Predictor of Prostate Cancer

TON - Daily
A rise in prostate-specific antigen (PSA)—known as PSA velocity—does not predict the likelihood of prostate cancer in asymptomatic men according to a study published in the Journal of the National Cancer Institute. Researchers from Memorial Sloan-Kettering Cancer Center (MSKCC) in New York said relying solely on PSA velocity to determine who should undergo biopsy would lead to hundreds of unnecessary biopsies without improving outcomes.
 
Current guidelines from the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN) call for men with PSA levels that rise sharply to have a biopsy, even if their PSA levels fall within normal limits and they have no signs or symptoms of prostate cancer. In a press release, Andrew Vickers, PhD, an attending research methodologist in the Department of Epidemiology and Biostatistics at MSKCC said, "We have found no evidence to support the recommendation that men with a high PSA velocity should be biopsied in the absence of other indications."
 
The investigators analyzed data for 5519 men aged 55 years and older in the placebo arm of the Prostate Cancer Prevention Trial. Participants had never received a prostate cancer diagnosis, had a normal digital rectal examination (DRE), and had a PSA level of 3.0 ng/ml or less. For 7 years, the men received annual PSA screening; anyone whose PSA level exceeded 3.9 ng/ml underwent a biopsy. The remaining prostate cancer-free patients had a biopsy at the study's conclusion.
 
Adding PSA velocity to other measures (age, PSA level, DRE, family history, and prior biopsy) to assess the patient’s need for biopsy did little to improve the likelihood of an accurate diagnosis. The area under the curve when incorporating PSA velocity in assessment measures was 0.709 compared with 0.702 when PSA velocity was excluded. The advantage for PSA velocity was even lower when considering high-grade cancer or clinically significant cancer.
 
High PSA levels alone demonstrated greater sensitivity than PSA velocity at predicting prostate cancer; specificity was comparable between the two measures. The authors concluded that PSA level alone predicted outcomes much better than PSA velocity and made PSA velocity unnecessary as a criteria for biopsy.
 
"PSA naturally varies from month-to-month," said Peter T. Scardino, MD, chair of the Department of Surgery at MSKCC. Other causes of PSA elevation include benign prostate conditions and urinary infections. Scardino said MSKCC often tells patients with a rise in PSA levels to come back again in 6 weeks for another test.
 
"This new study in a large population of men provides even stronger evidence that using changes in PSA as a basis for recommendation for biopsy leads to many more unnecessary biopsies and does not help to find the more aggressive cancers that we want to find and treat," Scardino said. He advised men to use caution before rushing to have a biopsy based on a minor increase in PSA levels. The authors concluded the study by recommending changes in current practice guidelines that use PSA velocity as a criteria for biopsy.

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