Changes in serum prostate‐specific antigen levels and the identification of prostate cancer in a large managed care population

Abstract

What's known on the subject? and What does the study add?• The use of a single, elevated PSA level to screen for prostate cancer is controversial given its reported low specificity and the questionable benefits of PSA screening on prostate cancer mortality. Current guidelines in the USA recommend against screening using a single PSA measurement. Previous studies suggest that using changes in PSA level over time, or PSA velocity, may improve the detection of prostate cancer and/or aggressive disease; however, this is also controversial as other studies suggest PSA velocity does not improve detection and may further contribute to the overdetection of indolent prostate cancer.• Given the questions that remain regarding the use of the rate of change in PSA as a screening tool for prostate cancer because of previous conflicting studies, which to date have included small, highly selected populations, this study adds to the existing knowledge by assessing this question in general practice settings among a large, diverse population. Objective• To determine whether the rate of change in total serum prostate-specific antigen (PSA) levels accurately detects prostate cancer and to evaluate whether it adds any predictive value to a single measurement of serum PSA alone, in general practice settings. Materials and Methods• A retrospective cohort of 219 388 community-dwelling men, aged Ն45 years, enrolled in the Kaiser Permanente Southern California health plan, with no history of prostate cancer and at least three PSA measurements, were followed from 1 January 1998 to 31 December 2007, for the development of biopsy-confirmed prostate cancer.• Annual percent changes in total serum PSA levels were estimated using linear mixed models.• The accuracy of prostate cancer prediction was assessed for prostate cancer overall and for aggressive disease (Gleason score Ն7) and compared with that of a single measure of PSA level using area under the receiver-operating characteristic curves (AUCs). Results• The men in this cohort experienced a mean change of 2.9% in PSA levels per year and the rate of change in PSA increased modestly with age (P Յ 0.001).• Annual percent changes in PSA accurately predicted the presence of prostate cancer (AUC = 0.963) and aggressive disease (AUC = 0.955) and had more predictive accuracy for aggressive disease than did a single measurement of PSA alone (AUC = 0.727). Conclusions• Longitudinal measures of PSA improve the accuracy of aggressive prostate cancer detection when compared with a single measurement of PSA alone.• Findings from this study provide insight into the usefulness of PSA velocity as a detection marker for aggressive prostate cancer.

Prognostic significance of the tumour-adjacent tissue in head and neck cancers

“…However, there is still a considerable variation in the prognosis within a group of patients sharing the same clinicopathological characteristics. No clinically useful prognostic biomarkers similar to the HER2 or oestrogen receptor in breast cancers [6], nor PSA in prostate [7] have been found yet for HNSCC [8]. Accordingly, an assessment of the mRNA expressing patterns of particular tumours should be useful.…”

Primary extragonadal germ cell tumor: A case report on prostate seminoma

“…The present study highlights that findings should be combined with biochemical tests such as that for PSA. PSA in patients with prostate cancer is usually higher than normal (12). If the disease can be recognized and confirmed initially, the correct pathological diagnosis can be obtained.…”

Management of Men with a Suspicion of Prostate Cancer after Negative Initial Prostate Biopsy Results

“…The PSA velocity is reported as 0.4-0.7 ng/ml/year in cancer cases [42,43,44], although in another study it was not an independent predictor [45]. Similarly, the change in PSA from baseline was a distinguishing factor, and an annual 3% change was reported as a cut-off value [46]. PSA doubling time has been described as a useful marker for screening.…”