Prostate specific antigen volatility and the diagnosis of clinically significant prostate cancer
Guidelines support multiple approaches to improve PSA-based prostate cancer screening with the goal of increasing our ability to identify men most likely to harbor clinically significant prostate cancer, while avoiding overdiagnosis. Soon after PSA was discovered, it became clear that men with prostate cancer were more likely to experience rising PSA levels compared with men with benign prostatic hypertrophy. Subsequent models used in the detection of prostate cancer and in risk stratification have been improved by including more than one PSA measurement and examining how PSA measurements change over time (e.g. PSA velocity).
We hypothesize that increasing PSA variability – the change between screening PSA measurements – is inversely associated with clinically significant prostate cancer and that quantifying the variability in subsequent PSA measurements might help identify men with clinically significant prostate cancer.
- determine the amount of PSA variability among a cohort undergoing PSA based prostate cancer screening.
- determine if PSA variability is independently associated with a diagnosis of prostate cancer, and with clinically significant prostate cancer
- determine the performance of measures of PSA variability in specific patient cohorts based on age, race/ethnicity, other comorbidity.
Priyadip Ray, PhD - Lawrence Livermore National Laboratory
James Brooks, MD - Stanford University