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Prostate Cancer and Prostatic Diseases (2006) 9, 169172& 2006 Nature Publishing Group All rights reserved 1365-7852/06 $30.00www.nature.com/pcanORIGINAL ARTICLEPSA velocity and PSA slopeL BenecchiDepartment of Urology, Fidenza Hospital, Parma, ItalyThe aim of this study is to compare different tools for evaluating prostate-specific antigen (PSA)
increase or decrease, such as PSA velocity and PSA slope. This study was conducted on 312 male
patients evaluated with transrectal ultrasound-guided biopsy of prostate with six or more cores.
Patients with at least three consecutive PSA measurements in at least 18 months entered the study.
Prostate-specific antigen slope was estimated by the slope of the least-square regression line fit to PSA
versus time in years; PSA velocity was calculated with 3 or more PSA arrays. Median age was 66 years
(range 4586). Overall 67 patients were affected by primary prostate cancer, 245 were controls without
prostate cancer. Prostate-specific antigen slope and PSA velocity were significantly higher in patients
with prostate cancer than in controls. At the ROC analysis, PSA slope evidenced better results than
PSA velocity (area under the curve (AUC) 0.743 for PSA slope; AUC 0.663 for PSA velocity; P 0.037).
At PSA slope (calculated with the least-square fit) equal to zero, the sensitivity resulted as being 94%
with a specificity of 38.8%. In conclusion prostate-specific antigen slope calculated with three or more
PSA assays permits longitudinal evaluation of PSA for prostate diagnosis. Prostate-specific antigen
slope improves both sensitivity and specificity in prostate cancer diagnosis, compared with PSA
velocity.Prostate Cancer and Prostatic Diseases (2006) 9, 169172. doi:10.1038/sj.pcan.4500866; published online
28 March 2006Keywords: prostate-specific antigen; PSA velocity; PSA slopeIntroductionProstate cancer will become a social emergency in the near
future in Western countries because it is one of the leading
causes of cancer death, and because it tends to increase
with age more rapidly than many other malignancies.
However, the conventional strategy for prostate-specific
antigen (PSA) screening, which calls for biopsies in all
men with total PSA (tPSA) greater than 4 ng/ml, leads to
many false-positive results and is thus associated with a
high cost in terms of unnecessary biopsies.1The cost is not only economic but also psychological
and emotional as anxiety on the part of the patient and
his family can be of considerable detriment to his well
being. Considerable efforts...