Journal List > Korean J Urol > v.50(6) > 1005347

TOOLS
Park, Kim, Ahn, Kim, Choi, and Kim: Short-term Prostate-Specific Antigen Velocity Measurement before Prostate Biopsy
Original Article

Korean J Urol 2009;50(6):553-559.

Published online: 19 June 2009

DOI: https://doi.org/10.4111/kju.2009.50.6.553

Short-term Prostate-Specific Antigen Velocity Measurement before Prostate Biopsy

Jong Tak Park, Se Joong Kim, Hyun Soo Ahn, Young Soo Kim, Jong Bo Choi, Sun Il Kim

From the Department of Urology, Ajou University School of Medicine, Suwon, Korea

Correspondence to: Sun Il Kim Department of Urology, Ajou University School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, Korea TEL: 031-219-5274 FAX: 031-219-5276 E-mail: sikimuro@ajou.ac.kr

Received 12 May 2009       Accepted 21 January 2009

Copyright © 2009 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

We investigated whether a short-term follow-up prostate-specific antigen (PSA) measurement before prostate biopsy is useful in predicting the presence of prostate cancer.

Materials and Methods:

From January 2004 to May 2008, 670 patients underwent transrectal ultrasound-guided prostate biopsy. The initial PSA (PSA1) was measured at the first outpatient visit. The second PSA (PSA2) was measured the evening before prostate biopsy. Only the patients with a PSA1 between 2.5 and 20 ng/ml and an interval between PSA1 and PSA2 of between 7 and 90 days were included in this study. The short-term PSA velocity (PSAVm) was defined as {(PSA2−PSA1/interval (days)}x30. Prostate volume (PV), PSA1, PSA2, and PSAVm were compared between the patients with prostate cancer and those with benign histology.

Results:

Of the 362 patients who fulfilled the entry criteria, 365 prostate biopsies were performed. The PSAVm differed significantly between patients with prostate cancer and those with benign histology (p=0.021). In patients with a PSA1 of 10-20 ng/ml, age, PV, PSA1, PSA2, and PSAVm were significantly different between patients with prostate cancer and those with benign histology, whereas in patients with a PSA1 of 2.5-10 ng/ml, only PV was significantly different. In multivariate logistic regression analysis excluding PSA1 and PSA2, PSAVm was a significant predictor of prostate cancer overall and in patients with a PSA1 of 10-20 ng/ml, but not in patients with a PSA1 of 2.5-10 ng/ml.

Conclusions:

PSAVm was significantly different between the benign group and the prostate cancer group. But, this difference was mainly the result of a falsely elevated PSA, and PSAVm was not a significant predictor of prostate cancer when the PSA1 was 2.5-10 ng/ml.

Keywords: Prostate-specific antigen, Biopsy, Prostatic neoplasms

REFERENCES

1.Kim WJ., Chung JI., Hong JH., Kim CS., Jung SI., Yoon DK. Epidemiological study for urologic cancer in Korea (1998-2002). Korean J Urol. 2004. 45:1081–8.
2.Ravery V., Meulemans A., Boccon-Gibod L. Clearance of free and total serum PSA after prostatic surgery. Eur Urol. 1998. 33:251–4.
crossref
3.Barry MJ. Clinical practice. Prostate-specific-antigen testing for early diagnosis of prostate cancer. N Engl J Med. 2001. 344:1373–7.
4.Djavan B., Zlotta A., Kratzik C., Remzi M., Seitz C., Schulman CC, et al. PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4.0 ng/ml. Urology. 1999. 54:517–22.
crossref
5.Carter HB., Pearson JD., Waclawiw Z., Metter EJ., Chan DW., Guess HA, et al. Prostate-specific antigen variability in men without prostate cancer: effect of sampling interval on prostate-specific antigen velocity. Urology. 1995. 45:591–6.
crossref
6.Kim JY., Cho JS., Kwon MS., Jang WS., Park SY., Chung BS, et al. Biological variation of serum prostate specific antigen levels in men aged 50 or older without prostate cancer. Korean J Urol. 2006. 47:1284–8.
crossref
7.Prestigiacomo AF., Stamey TA. Physiological variation of serum prostate specific antigen in the 4.0 to 10.0 ng./ml. range in male volunteers. J Urol. 1996. 155:1977–80.
crossref
8.Roehrborn CG., Pickens GJ., Carmody T 3rd. Variability of repeated serum prostate-specific antigen (PSA) measurements within less than 90 days in a well-defined patient population. Urology. 1996. 47:59–66.
crossref
9.Morote J., Raventós CX., Lorente JA., Enbabo G., López M., de Torres I. Intraindividual variations of total and percent free serum prostatic-specific antigen levels in patients with normal digital rectal examination. Eur Urol. 1999. 36:111–5.
crossref
10.Lynn NN., Collins GN., O'Reilly PH. The short-term prostate-specific antigen velocity before biopsy can be used to predict prostatic histology. BJU Int. 2000. 85:847–50.
crossref
11.Partin AW., Carter HB., Chan DW., Epstein JI., Oesterling JE., Rock RC, et al. Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. J Urol. 1990. 143:747–52.
crossref
12.Song C., Ahn H., Lee MS., Park J., Kwon TG., Kim HJ, et al. Mass screening for prostate cancer in Korea: a population based study. J Urol. 2008. 180:1949–52.
crossref
13.Bruun L., Becker C., Hugosson J., Lilja H., Christensson A. Assessment of intra-individual variation in prostate-specific antigen levels in a biennial randomized prostate cancer screening program in Sweden. Prostate. 2005. 65:216–21.
crossref
14.Piironen T., Pettersson K., Suonpää M., Stenman UH., Oesterling JE., Lövgren T, et al. In vitro stability of free prostate-specific antigen (PSA) and prostate-specific antigen (PSA) complexed to alpha 1-antichymotrypsin in blood samples. Urology. 1996. 48(6A Suppl):81–7.
15.Cho CR., Um TH. Evaluation of immunochemical autoa-nalyzer Modular Analytics(R). J Lab Med Qual Assur. 2005. 27:219–25.
16.Sölétormos G., Semjonow A., Sibley PE., Lamerz R., Petersen PH., Albrecht W, et al. Biological variation of total prostate-specific antigen: a survey of published estimates and consequences for clinical practice. Clin Chem. 2005. 51:1342–51.
17.Kobayashi M., Nukui A., Morita T. Serum PSA and percent free PSA value changes after antibiotic treatment. A diagnostic method in prostate cancer suspects with asymptomatic prostatitis. Urol Int. 2008. 80:186–92.
18.Ng MK., Van As N., Thomas K., Woode-Amissah R., Horwich A., Huddart R, et al. Prostate-specific antigen (PSA) kinetics in untreated, localized prostate cancer: PSA velocity vs PSA doubling time. BJU Int. 2009. 103:872–6.
crossref
19.Takechi H., Ito K., Yamamoto T., Miyakubo M., Ohi M., Suzuki K. Prostate-specific antigen kinetics in screen-detected prostate cancer in Japan. Urology. 2008. 72:1111–5.
crossref

Fig. 1
Receiver operating characteristics (ROC) curves of PSA1, PSA2, and PSAVm. PSA1: initial prostate-specific antigen (PSA), PSA2: PSA measured the evening before prostate biopsy, PSAVm: short-term PSA velocity.
kju-50-553f1.tif
Fig. 2
Receiver operating characteristics (ROC) curves of PSA1, PSA2, and PSAVm when PSA1 was 2.5-10 ng/ml. PSA1: initial prostate-specific antigen (PSA), PSA2: PSA measured the evening before prostate biopsy, PSAVm: short-term PSA velocity.
kju-50-553f2.tif
Table 1.
Comparison between patients with prostate cancer and those with benign histology
Variables Total Cancer group Benign group Univariatea p-value OR (95% CI) Multivariateb p-value
No. of cases 362 104 (29%) 258 (71%)      
Age (years) 65.9 (12) 67.5 (11) 65.4 (13) 0.001 1.07 (1.05-1.10) ＜0.001
Interval between PSA1 29 (20) 26.0 (20) 30.0 (19) 0.072    
and PSA2 (days)            
Prostate volume (ml) 43.0 (28.5) 37.9 (18.8) 47.3 (28.4) ＜0.001 0.97 (0.96-0.98) ＜0.001
PSA1 (ng/ml) 6.70 (4.02) 7.87 (6.19) 6.55 (3.66) 0.006    
PSA2 (ng/ml) 6.07 (3.84) 7.54 (5.96) 5.85 (3.23) ＜0.001    
PSAVm (ng/ml/month) －0.58 (2.1) －0.20 (2.2) －0.70 (2.2) 0.002 1.10 (1.01-1.89) 0.021

Values are expressed as median (interquartile range). PSA1 and PSA2 were excluded from the multivariate analysis. OR: odds ratio, CI: confidential interval, PSA1: initial prostate-specific antigen (PSA), PSA2: PSA measured the evening before prostate biopsy, PSAVm: short-term PSA velocity.

a : analyzed by Mann-Whitney U test,

b : analyzed by multivariate logistic regression model

Table 2.
Comparison of variables according to subgroup
Variables Antibiotics intake p-value Detection during PSA follow-up p-value Detection from health promotion center p-value
  Yes No   Yes No   Yes No  
No. of cases 49 313   77 285   41 321  
Age (years) 48.5 (25) 66.9 (11) ＜0.001a 65.9 (10) 66.0 (13) 0.679a 55.5 (19) 66.7 (11) ＜0.001a
Prostate volume (ml) 31.8) (23.8) 45.0 (28.0) ＜0.001a 46.1 (31.9) 42.8 (27.1) 0.182a 33.2 (25.7) 43.9 (28.6) 0.002a
PSA1 (ng/ml) 6.10 (2.65) 6.92 (4.24) 0.032a 6.79 (3.80) 6.64 (4.19) 0.675a 6.59 (3.93) 6.77 (3.98) 0.268a
PSA2 (ng/ml) 5.72 (2.88) 6.20 (4.04) 0.538a 5.92 (3.47) 6.20 (3.99) 0.858a 5.48 (4.43) 6.20 (3.69) 0.121a
PSAVm (ng/ml/month) －0.14 (1.9) －0.60 (2.1) 0.492a －0.51 (1.4) －0.60 (2.2) 0.900a －0.26 (2.3) －0.60 (2.1) 0.783a
No. of prostate cancer 10 (20.4%) 94 (30.0%) 0.179b 15 (19.5%) 89 (31.2%) 0.047b 11 (26.8%) 93 (29.0%) 0.856b

Values are expressed as median (interquartile range). PSA1: initial prostate-specific antigen (PSA), PSA2: PSA measured the evening before prostate biopsy, PSAVm: short-term PSA velocity.

a :analyzed by Mann-Whitney U test,

b : analyzed by chi-square test

Table 3.
Comparison between patients with prostate cancer and those with benign histology when the PSA1 was 10-20 ng/ml
Variables Total Cancer group Benign group Univariatea p-value OR (95% CI) Multivariateb p-value
No. of cases 70 33 (47.1%) 37 (52.9%)      
Age (years) 69.3 (14) 71.2 (11) 66.7 (13) 0.014 1.06 (0.99-1.13) 0.088
Prostate volume (ml) 47.1 (40.3) 42.9 (26.1) 60.9 (44.8) 0.009 0.99 (0.98-1.00) 0.352
PSA1 (ng/ml) 12.23 (4.58) 12.97 (5.66) 11.70 (4.42) 0.038    
PSA2 (ng/ml) 11.14 (5.66) 13.70 (6.76) 9.64 (6.20) ＜0.001    
PSAVm (ng/ml/month) －1.49 (4.6) 0.00 (3.6) －2.10 (3.9) 0.001 1.19 (1.03-1.37) 0.016

Values are expressed as median (interquartile range). PSA1 and PSA2 were excluded from the multivariate analysis. OR: odds ratio, CI: onfidential interval, PSA1: initial prostate-specific antigen (PSA), PSA2: PSA measured the evening before prostate biopsy, PSAVm: hort-term PSA velocity.

a : analyzed by Mann-Whitney U test,

b : analyzed by multivariate logistic regression model

Table 4.
Comparison between patients with prostate cancer and those with benign histology when the PSA1 was 2.5-10 ng/ml
Variables Total Cancer group Benign group Univariatea p-value OR (95% CI) Multivariateb p-value
No. of cases 292 71 (24.3%) 221 (75.7%)      
Age (years) 65.7 (12) 65.9 (10) 65.3 (13) 0.087    
Prostate volume (ml) 42.5 (26.0) 36.8 (17.6) 46.1 (26.6) ＜0.001 0.96 (0.95-0.98) ＜0.001
PSA1 (ng/ml) 6.09 (2.70) 5.90 (3.42) 6.20 (2.46) 0.968    
PSA2 (ng/ml) 5.53 (2.86) 5.84 (3.45) 5.50 (2.46) 0.152    
PSAVm (ng/ml/month) －0.47 (1.8) －0.25 (1.4) －0.52 (1.9) 0.053 1.07 (0.98-1.17) 0.149

Values are expressed as median (interquartile range). PSA1 and PSA2 were excluded from the multivariate analysis. OR: odds ratio, CI:confidential interval, PSA1: initial prostate-specific antigen (PSA), PSA2: PSA measured the evening before prostate biopsy, PSAVm:short-term PSA velocity.

a : analyzed by Mann-Whitney U test,

b : analyzed by multivariate logistic regression model

Table 5.
Comparison of PSA1 and PSA2 in each subgroup
Subgroup Pathology PSA1 PSA2 p-value
PSA1 2.5-10 ng/ml Cancer Benign 5.90 (3.42) 6.20 (2.46) 5.84 (3.45) 5.50 (2.46) 0.051 ＜0.001
PSA1 Cancer 12.97 (5.66) 13.70 (6.76) 0.940
10-20 ng/ml Benign 11.70 (4.42) 9.64 (6.20) ＜0.001

Values are expressed as median (interquartile range). PSA1: initial prostate-specific antigen (PSA), PSA2: PSA measured the evening before prostate biopsy

TOOLS
Similar articles