Prostate-specific antigen velocity for early detection of prostate cancer: result from a large, representative, population-based cohort

Eur Urol. 2009 Nov;56(5):753-60. doi: 10.1016/j.eururo.2009.07.047. Epub 2009 Aug 7.


Background: It has been suggested that changes in prostate-specific antigen (PSA) over time (ie, PSA velocity [PSAV]) aid prostate cancer detection. Some guidelines do incorporate PSAV cut points as an indication for biopsy.

Objective: To evaluate whether PSAV enhances prediction of biopsy outcome in a large, representative, population-based cohort.

Design, setting, and participants: There were 2742 screening-arm participants with PSA <3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer in Rotterdam, Netherlands, or Göteborg, Sweden, and who were subsequently biopsied during rounds 2-6 due to elevated PSA.

Measurements: Total, free, and intact PSA and human kallikrein 2 were measured for 1-6 screening rounds at intervals of 2 or 4 yr. We created logistic regression models to predict prostate cancer based on age and PSA, with or without free-to-total PSA ratio (%fPSA). PSAV was added to each model and any enhancement in predictive accuracy assessed by area under the curve (AUC).

Results and limitations: PSAV led to small enhancements in predictive accuracy (AUC of 0.569 vs 0.531; 0.626 vs 0.609 if %fPSA was included), although not for high-grade disease. The enhancement depended on modeling a nonlinear relationship between PSAV and cancer. There was no benefit if we excluded men with higher velocities, which were associated with lower risk. These results apply to men in a screening program with elevated PSA; men with prior negative biopsy were not evaluated in this study.

Conclusions: In men with PSA of about ≥3 ng/ml, we found little justification for formal calculation of PSAV or for use of PSAV cut points to determine biopsy. Informal assessment of PSAV will likely aid clinical judgment, such as a sudden rise in PSA suggesting prostatitis, which could be further evaluated before biopsy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Area Under Curve
  • Biopsy
  • Decision Support Techniques
  • Early Detection of Cancer*
  • Humans
  • Logistic Models
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Multicenter Studies as Topic
  • Neoplasm Staging
  • Netherlands
  • Predictive Value of Tests
  • Prognosis
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / immunology*
  • Prostatic Neoplasms / pathology
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Factors
  • Sweden
  • Time Factors
  • Tissue Kallikreins / blood
  • Up-Regulation


  • Tissue Kallikreins
  • Prostate-Specific Antigen