Age Adjusted Prostate Specific Antigen and Prostate Specific Antigen Velocity Cut Points in Prostate Cancer Screening

Judd W. Moul, Leon Sun, James M. Hotaling, Nicholas J. Fitzsimons, Thomas J. Polascik, Cary N. Robertson, Philipp Dahm, Mitchell S. Anscher, Vladimir Mouraviev, Paul A. Pappas, David M. Albala

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Purpose: We identified age adjusted prostate specific antigen and prostate specific antigen velocity cut points for prostate cancer biopsy. Materials and Methods: A cohort of 33,643 men was retrieved from the Duke Prostate Center database. Of this group 11,861 men with 2 or more prostate specific antigen values within 2 years were analyzed for age adjusted prostate specific antigen and prostate specific antigen velocity performance in cancer risk assessment using a receiver operating characteristic curve. Results: In the 11,861 men prostate cancer prevalence was 273 (8.0%), 659 (14.9%) and 722 (17.9%) in the groups of men 50 to 59 years old, 60 to 69 and 70 years old or older. In prostate cancer groups median prostate specific antigen and prostate specific antigen velocity in men 50 to 59 vs 70 years old or older were 5.6 vs 8.1 ng/ml and 1.37 vs 1.89 ng/ml per year (<0.0001). In men 50 to 59 years old the sensitivity and specificity were 82.1% and 80.7% at prostate specific antigen 2.5 ng/ml, and 84.3% and 72.4% at prostate specific antigen velocity 0.40 ng/ml per year, higher than those in men 70 years old or older at prostate specific antigen 4.0 ng/ml or prostate specific antigen velocity 0.75 ng/ml per year. Decreasing the prostate specific antigen cut point to 2.0 ng/ml and the prostate specific antigen velocity cut point to 0.40 ng/ml per year in men 50 to 59 years old improved the cancer detection rate but decreased the positive predictive value. Conclusions: Current biopsy guidelines (prostate specific antigen 4.0 ng/ml or greater, or prostate specific antigen velocity 0.75 ng/ml or greater per year) underestimated cancer risk in men 50 to 59 years old. Prostate specific antigen and prostate specific antigen velocity cut points should be age adjusted. In men 50 to 59 years old prostate specific antigen and prostate specific antigen velocity cut points could be decreased to 2.0 ng/ml and 0.40 ng/ml per year, respectively. Factors of age, sensitivity, specificity, positive predictive value and cancer prevalence are critical for obtaining the desired balance between cancer detection and negative biopsy.

Original languageEnglish (US)
Pages (from-to)499-504
Number of pages6
JournalJournal of Urology
Volume177
Issue number2
DOIs
StatePublished - Feb 2007

Keywords

  • ROC curve
  • age groups
  • differential threshold
  • predictive value of tests
  • prevalence

Fingerprint Dive into the research topics of 'Age Adjusted Prostate Specific Antigen and Prostate Specific Antigen Velocity Cut Points in Prostate Cancer Screening'. Together they form a unique fingerprint.

  • Cite this

    Moul, J. W., Sun, L., Hotaling, J. M., Fitzsimons, N. J., Polascik, T. J., Robertson, C. N., Dahm, P., Anscher, M. S., Mouraviev, V., Pappas, P. A., & Albala, D. M. (2007). Age Adjusted Prostate Specific Antigen and Prostate Specific Antigen Velocity Cut Points in Prostate Cancer Screening. Journal of Urology, 177(2), 499-504. https://doi.org/10.1016/j.juro.2006.09.063