1919 psa slope as a predictor of prostate cancer & high grade cancer on repeat biopsy

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 20121919 PSA SLOPE AS A PREDICTOR OF PROSTATE CANCER & HIGH GRADE CANCER ON REPEAT BIOPSY Ahmed El-Shafei, Osama Zaytoun, Ethan Vargo, Jianbo Li, Ryan Berglund, Micheal Gong, and Stephen Jones Ahmed El-ShafeiAhmed El-Shafei Cleveland, OH More articles by this author , Osama ZaytounOsama Zaytoun Cleveland, OH More articles by this author , Ethan VargoEthan Vargo Cleveland, OH More articles by this author , Jianbo LiJianbo Li Cleveland, OH More articles by this author , Ryan BerglundRyan Berglund Cleveland, OH More articles by this author , Micheal GongMicheal Gong Cleveland, OH More articles by this author , and Stephen JonesStephen Jones Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2076AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PSA kinetics including PSA slope, PSA velocity & PSA doubling time are used as predictors of prostate cancer (PCa) therapeutic outcome, disease prognosis & cancer-specific mortality. However there is a debate about use of these parameters in PCa screening. It was suggested that PSA velocity increased the specificity for detection of clinically significant prostate cancer. Furthermore there are limited guidelines for its use in continued screening of men with negative prostate biopsy. Our aim is evaluation of PSA slope as a predictive parameter for detection of both PCa & high grade PCa in men with one previous negative prostate biopsy. METHODS Between March 2000 and February 2010, we identified data to calculate PSA slope for 449 patients who underwent repeat transrectal ultrasound guided biopsy after initial negative biopsy. 50% of patients had >12 cores obtained on the first biopsy comparing to 78% on the repeated biopsy. All biopsies had a minimum of 8 cores. Variables of interest were age, prostate specific antigen (PSA), % free PSA, total prostate volume, pathological findings on first biopsy (ASAP, PIN) and PSA slope. PSA slope was calculated as (PSA2-PSA1)/time elapsed between the two measurements in years. Univariate and multivariate analysis as well as area under the receiver operating characteristic curve (ROC AUC) to assess predictive accuracy of different variables regarding detection of prostate cancer(PCa) and high grade PCa (Gleason score (GS)> 7). RESULTS PCa was detected in 102/449 (22.7%) patients. Of 102 patients with positive biopsy 72 patients (70%) were low grade while 30 (29.4%) were high grade (> GS 7). The mean age was 61.6 years and the mean time interval between the two PSA measurements with mean PSA value of 6.4 & 7.6 ng/ml at the time of the first & second biopsy with a mean PSA slope 0.71 ng/ml/year. PSA slope, patient age, and prostate volume were the most accurate predictors of PCa and high grade PCa on univariate analysis. Multivariable logistic regression analysis showed an AUC of 0.65 and 0.68 for PCa and high grade PCa, respectively with PSA slope had the highest predictive value alone with AUC 0.54 and 0.68 for PCa and high grade PCa, respectively. The best cutoff of PSA slope was 0.75 ng/ml/year with sensitivity of 0.88 and specificity of 0.45. CONCLUSIONS In men pursuing a second biopsy after an initial negative biopsy, PSA slope has higher predictive value than total PSA for both PCa and high grade PCa. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e774 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed El-Shafei Cleveland, OH More articles by this author Osama Zaytoun Cleveland, OH More articles by this author Ethan Vargo Cleveland, OH More articles by this author Jianbo Li Cleveland, OH More articles by this author Ryan Berglund Cleveland, OH More articles by this author Micheal Gong Cleveland, OH More articles by this author Stephen Jones Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...