PSA velocity pre-biopsy: has Vickers’ hypothesis been proven?

PSA velocity is, at present, included in National Comprehensive Cancer Network guidelines as a potential prognostic factor for need for a prostate biopsy. However, Vickers and colleagues argue that calculation of PSA velocity adds nothing to the ability to predict risk for a diagnosis of prostate cancer on biopsy by comparison with simpler PSA data.

A recent study appears to offer at least initial justification for Vickers’ hypothesis, although it is probably not accurate to call this a final proof.

Bittner et al. evaluated the effect of PSA velocity (PSAV) on prostate cancer diagnosis, Gleason score, tumor location, and cancer volume in men undergoing transperineal template-guided mapping biopsiess (TTMBs). PSAV has been associated with risk for higher Gleason scores and greater prostate cancer-specific mortality.

From January 2005 through September 2007, 217 patients underwent TTMBs. To be eligible for inclusion in this study, the patients had to have a persistently elevated PSA level and/or diagnosis of atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia on a previous biopsy. The prostate gland was arbitrarily divided into 24 regions, and a median of 58 cores were obtained per patient. The patients were also divided into three PSA velocity cohorts according to the following changes in PSA level in the year before biopsy: ≤ 0.0, 0.1-1.9, and ≥ 2.0 ng/ml. The PSAV was evaluated as a predictor for prostate cancer diagnosis, Gleason score, tumor volume, and cancer location.

The results of this study showed the following:

  • The mean (average) patient age was 64.2 years, with a mean prebiopsy PSA level of 8.5 ng/ml.
  • Prostate cancer was diagnosed in 97/217 patients (44.7 percent).
  • The study population had undergone an average of 1.8 ± 1.0 biopsies before TTMB.
  • PSAV did not predict for prostate cancer diagnosis (P = .84), Gleason score (P = .78), the percentage of positive cores (P = .37), or tumor location.

The authors conclude that, “Among patients with persistently elevated PSA levels despite previously negative biopsy findings, PSAV did not reliably predict for a diagnosis of prostate cancer nor did it correlate with prostate cancer grade, volume, or location using TTMB.”

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