How useful is PSA velocity as a Screening Tool for Prostate Cancer Detection?  

Oleh:

Porter, Christopher R.

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 34 no. 10 (Oct. 2007), page 474.

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2007.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Background : To compare longitudinal PSA changes in men in a screening population who went on to develop prostate cancer and those who showed no evidence of disease, and to examine the PSA kinetics in each group. Design : This retrospective study reviewed data from a PSA screening project launched in 1993 in Tyrol, Austria. From 1988 to 1992, digital rectal examination was used along side PSA in the diagnostic work-up. Prostate biopsies were recommended according to age-referenced PSA level combined with percent-free PSA <22%. As of 1995, biopsies were recommended according to bisected PSA levels combined with a percent-free PSA of 18%, a PSA level >10 ng/ml, or suspicious digital rectal examination result. The study included patients without malignancies who underwent PSA testinf every 2 years over 10 years period, and patient who were eventually diagnosed with prostat cancerwho underwent PSA testing minimum of six times over 6 to 10 years. Exclution criteria included a history of prostate surgery and treatment with 5-alpha-reductase inhibitors or chemotherapy. Total PSA and percent-free PSA levels were measured. Result : A total o 528 patients in the screening population were eventually diagnosed with with prostate cancer, while 4,272 had no evidence of malignancy. Over the 10 year study period, the mean total PSA level increased from 1.16 ng/ml to 1.49 ng/ml (PSA velocity [PSAV] 0.03 ng/ml per year) in the men with no evidence of prostate cancer, compare with an incresed from 2.19 ng/ml to 6.09 ng/ml (PSAV 0.39 ng/ml per year) among the patients with prostate cancer. Throughout the study, younger men had lower total PSA levels, although PSAV was equal among the different age groups. In the patients who went on to develop prostate cancer, the PSA increased from 0.225 ng/ml per year in the 8 to 10 years leading up to the diagnosis to 0.98 ng/ml per year in the 2 years before diagnosis. Patient with stage pT3 to T4 disease had significantly greater PSAV than patients with organ confined disease (p<0.001), and there was a significant positive correlation between PSAV and Gleason score (p<0.001). Prostate volume was no significantly associated with PSAV. Conclusion : These findings suggest that the use of PSA kinetics in prostate cancer screening could help clinicians to identify patients with potentially curable prostate cancer.

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