Prostate-specific antigen velocity and the detection of gleason score 7 to 10 prostate cancer

Authors

  • Rinaa S. Punglia MD, MPH,

    Corresponding author
    1. Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
    • Dana-Farber Cancer Institute, Smith 274, 44 Binney Street, Boston, MA 02115
    Search for more papers by this author
    • Fax: (617) 632-2270

  • Jennifer Cullen PhD, MPH,

    1. Department of Surgery, Uniformed Services University of the Health Sciences and Center for Prostate Disease Research, Rockville, Maryland
    Search for more papers by this author
  • David G. McLeod MD,

    1. Department of Urology, Walter Reed Army Medical Center, Bethesda, Maryland
    Search for more papers by this author
  • Yongmei Chen MD, MPH,

    1. Department of Surgery, Uniformed Services University of the Health Sciences and Center for Prostate Disease Research, Rockville, Maryland
    Search for more papers by this author
  • Anthony V. D'Amico MD, PhD

    1. Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
    Search for more papers by this author

Abstract

BACKGROUND.

An increasing prostate-specific antigen (PSA) velocity is associated with a shorter survival after local therapy for prostate cancer. In this study, the authors evaluated whether PSA velocity was associated with prostate cancer detection and grade at diagnosis after adjusting for established predictors.

METHODS.

Between January 1989 and December 2003, 914 men who had PSA levels ≥4 ng/mL were identified by using the Center for Prostate Disease Research (CPDR) multicenter national database, including 541 men who were diagnosed with prostate cancer. Multivariable logistic regression analyses were performed that included continuous variables (PSA velocity and level, number of prior negative biopsies, and age) along with categorical variables (ethnicity and family history) were used to identify the factors associated with prostate cancer detection and grade.

RESULTS.

An increasing PSA velocity was associated with Gleason scores from 7 to 10 versus Gleason scores form 2 to 6 or no cancer (adjusted odds ratio [OR], 1.04 ng/mL per year; 95% confidence interval [95% CI], 1.003–1.085 ng/mL per year; P = .035). This finding was not evident in patients who had prostate cancers with Gleason scores between 2 and 6 or for any prostate cancer. PSA level was associated with the detection of any prostate cancer (OR, 1.06 ng/mL; 95% CI, 1.03–1.10 ng/mL; P = .004) and Gleason score ≤6 prostate cancer (OR, 1.06 ng/mL; 95% CI, 1.02–1.10 ng/mL; P = .0027); however, in the presence of PSA velocity, PSA no longer remained independently predictive for high-grade prostate cancer (OR, 1.01 ng/mL; 95% CI, 0.98–1.04 ng/mL; P = .45) after adjusting for established predictors.

CONCLUSIONS.

PSA velocity enhanced the detection of high-grade cancer in men who had PSA levels >4 ng/mL. These findings, in conjunction with life expectancy, may be used when deciding which men should not be recommended for prostate biopsy despite a PSA level >4 ng/mL. Cancer 2007. © 2007 American Cancer Society.

Ancillary