Long-Term Prediction Of Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 03 May 2008 - 0:00 PDT

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UroToday.com - In the February 20, 2008 issue of the Journal of Clinical Oncology, Dr. Ulmert and associates suggest that PSA velocity (PSAV) does not add to PSA in predicting the long-term risk of prostate cancer (CaP). The study was performed using the Malmö Preventive Medicine database, and included 4,907 men who had a blood sample drawn between 1974 and 1986 to investigate risk factors for cardiovascular and metabolic diseases. The men in the database had a second blood sample taken 6 years later. Information regarding the occurrence and date of CaP were obtained from the Swedish National Cancer Registry. CaP was identified in 443 of the 4,907 men (9%). The median PSA and participant age was similar among cases and controls. Levels of total PSA (tPSA), free PSA (fPSA), and the PSAV were entered into a predictive model.

The median follow-up time for men without CaP was 21 years and the 20-year cancer-free probability was 90.5%. The tPSA level at second assessment showed greater spread of risk than the velocities. The authors cite an example of the 20-year probability of CaP diagnosis at median tPSA (10.6% risk) was half the risk at the 95th percentile of tPSA (21.2% risk), whereas the risk for tPSAV increased form 9.1% at median tPSAV to 14.1% risk at the 95th percentile. While PSAV was informative in univariate analysis, addition of tPSAV to the model including tPSA level did not enhance predictive accuracy for CaP. They stated that this result was likely due to the high correlation between tPSA and tPSAV. The researchers also found no enhanced predictive value from tPSAV among patients diagnosed with advanced CaP.

In an accompanying editorial (Prostate-specific antigen (PSA) and PSA velocity: competitors or collaborators in the prediction of curable and clinically significant prostate cancer J Clin Oncol. 2008;26:823-4) Dr. Anthony D'Amico points out that the authors are using tPSA and tPSAV as competitive in the model, although both are informative for predicting CaP. He states that despite the high correlation coefficient between the two variables, they can both add to the determination of risk of CaP.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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