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Prostate-Specific Antigen Velocity No Indication for Biopsy

Using high prostate-specific antigen velocity as an indicator may lead to unnecessary biopsies

FRIDAY, Feb. 25 (HealthDay News) -- A current guideline on early detection of prostate cancer, which recommends biopsy based on high prostate-specific antigen (PSA) velocity even without other indications, may lead to many unnecessary biopsies, according to a study published online Feb. 24 in the Journal of the National Cancer Institute.

Andrew J. Vickers, Ph.D., of the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues evaluated the validity of using high PSA velocity as an indication for biopsy, even in the absence of a raised PSA or a positive digital rectal exam (DRE). The predictive accuracy of PSA velocity was assessed in 5,519 men in the placebo arm of the Prostate Cancer Prevention Trial who had undergone a biopsy, regardless of clinical indication. Results were adjusted for age, PSA levels, DRE, family history, and prior biopsy.

The researchers found that PSA velocity did not increase the predictive accuracy of high PSA levels or a positive DRE. Among men with no other indications for biopsy, high PSA velocity would necessitate biopsies in nearly one in seven men. For cut-off levels of PSA and PSA velocity with similar specificities, the PSA thresholds had a higher sensitivity (23 versus 19 percent), particularly for high-grade and clinically significant cancers.

"We found no reason to believe that implementation of the guideline would improve patient outcomes; indeed, its use would lead to a large number of unnecessary biopsies. We therefore recommend that organizations issuing policy statements related to PSA and prostate cancer detection remove references to PSA velocity," the authors write.

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