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Age Adjusted Prostate Specific Antigen And Prostate Specific Antigen Velocity Cut Points In Prostate Cancer Screening

April 23, 2017

UroToday- Traditional recommendations for prostate biopsy have included a total serum PSA of 4.0 ng/ml or greater and a PSA velocity of 0.75 ng/ml per year or greater. While recent trends have moved towards a PSA threshold of 2.5 ng/ml or greater in men younger than 65 years, specific recommendations for PSA velocity thresholds in younger men have not been agreed upon.

In the February issue of the Journal of Urology, Moul, Albala, and colleagues from Duke University report the results of a cohort of 33,643 men who formed part of a prostate serum PSA values over a 2 year period. Total PSA and PSA velocity threshold values with the highest sensitivity and specificity for prostate cancer detection were identified for men 50 to 59 years old.

In men cancer early detection study. Of these men, 11,861 patients were identified with 2 or more age 50 to 59 years, a serum PSA threshold for biopsy of 2.0 ng/ml or greater achieved the highest sensitivity (84%) when compared to thresholds of 2.5 ng/ml, 3.0 ng/ml, and 3.5 ng/ml with sensitivities of 82%, 79%, and 77%, respectively. The specificity of a PSA threshold of 2.0 ng/ml in these men was acceptable at 74.4%, which was not significantly different from the specificity of using a threshold of 2.5 ng/ml (80%).

Using a PSAv of 0.4 ng/ml/year in men age 50 to 59 years achieved a specificity of 84% and sensitivity of 72%, compared with a PSA threshold of 0.75 ng/ml with sensitivity and specificity of 70% and 84%, respectively.

These data from a large cohort of patients suggests that lowering the PSA threshold for biopsy in younger men is associated with an increase in sensitivity without compromising specificity significantly.

In the accompanying editorial, Ankerst and Thompson note that these data are not consistent with the results of the PCPT, which found a significantly lower rate of prostate cancer detection in this age group of patients. They explain these differences invoking verification bias, since a disproportionate number of men in the Moul study who underwent biopsy were included in the study and were referred with a serum PSA of 4.0 ng/ml or greater. In the PCPT, all men were biopsied regardless of their serum PSA. While the editorial comment is statistically correct, the Moul study is clinically relevant because its cohort was constituted by the "typical patient" who visits an early detection clinic.

Moul JW, Sun L, Hotaling JM, Fitzsimons NJ, Polascik TJ, Robertson CN, Dahm P, Anscher MS, Mouraviev V, Pappas PA, Albala DM

J Urol 2007 Feb; 177(2):499-503; discussion 503-4 Reviewed by UroToday Ricardo F. Sánchez-Ortiz, MD

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