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Association of prostate‐specific antigen doubling time and cancer in men undergoing repeat prostate biopsy
Author(s) -
Moreira Daniel M,
Gerber Leah,
Thomas JeanAlfred,
Bañez Lionel L,
McKeever Madeline G,
Freedland Stephen J
Publication year - 2012
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2012.03016.x
Subject(s) - medicine , prostate specific antigen , prostate cancer , prostate , rectal examination , hazard ratio , prostate biopsy , urology , doubling time , biopsy , confidence interval , antigen , oncology , cancer , immunology , biology , in vitro , biochemistry
Objectives: To analyze the association between prostate‐specific antigen doubling time with prostate cancer risk and grade among men with prostate‐specific antigen levels ≥4.0 ng/mL undergoing repeat prostate biopsy. Methods: A total of 286 patients with prostate‐specific antigen ≥4 ng/mL and available prostate‐specific antigen doubling time data, who underwent repeat prostate biopsy from 1996–2009, were included in this analysis. Prostate‐specific antigen doubling time was divided into three groups: >9 years, 3–9 years and <3 years. Multivariate analyses of prostate‐specific antigen doubling time with cancer risk and grade (≤3 + 4 vs ≥4 + 3) were carried out using logistic regression adjusting for prebiopsy prostate‐specific antigen, race, age, digital rectal examination, year of biopsy and number of prior negative biopsies. Results: The median prostate‐specific antigen doubling time before biopsy was 4.5 years (interquartile range = 2.5–10). Shorter prostate‐specific antigen doubling time was associated with higher prostate‐specific antigen ( P < 0.001), but it was unrelated to age, digital rectal examination or race. Shorter prostate‐specific antigen doubling time as a continuous variable was associated with greater prostate cancer risk in both uni‐ (hazard ratio = 0.99, 95% confidence interval = 0.98–0.99, P = 0.001) and multivariate analysis (hazard ratio = 0.99, 95% confidence interval = 0.98–0.99, P = 0.004). The prevalence of cancer among prostate‐specific antigen doubling time groups (>9, 3–9, <3 years) was 17%, 37% and 40%, respectively. Shorter prostate‐specific antigen doubling time groups were associated with higher cancer risk ( P = 0.001). Stratified by grade, short prostate‐specific antigen doubling time as a continuous variable significantly predicted both low‐ ( P = 0.010) and high‐grade disease ( P = 0.049). The inclusion of prostate‐specific antigen doubling time groups in a multivariate model to predict biopsy positivity increased its accuracy from 0.69 to 0.74. Conclusion: Prostate‐specific antigen doubling time seems to provide further cancer risk assessment in men undergoing repeat biopsy for prostate‐specific antigen ≥4.0 ng/mL. If validated in future studies, the present findings support the use of prostate‐specific antigen doubling time in the risk stratification of this patient population.