PSA velocity: A systematic review of clinical applications

BackgroundThe value of prostate-specific antigen (PSA) for screening and management of prostate cancer (CaP) continues to engender much controversy in the medical and lay literature. This review is intended to critically analyze the literature to assess the utility of adding the calculation of PSA velocity (PSAV) in the screening and management of CaP.MethodsA systematic review of electronic databases including Medline PaperChase, PubMed, and Scopus was conducted to identify English-language studies in the peer-reviewed literature from 1992 to 2013. The free text search was extended by adding the following keywords: prostate cancer, screening, surgery, radiation therapy, active surveillance, and PSAV. All matches from the searches were read, and the articles pertinent to an analysis of PSAV in clinical practice were included in this review.ResultsThe design of much of the recent published literature on PSAV does not conform to the original description of PSAV or to the published guidelines regarding the number of PSA values and the interval of time over which the PSA values are obtained. This heterogeneity of definition is the source of much of the controversy regarding the clinical applications of PSAV. The preponderance of evidence suggests that there is high collinearity between PSA and PSAV and therefore the calculation of PSAV adds little to the measurement of PSA level.ConclusionsPSAV calculation has been advocated by many investigators as a strategy to improve the screening and clinical management of patients with CaP. However, when PSAV definitions are rigorously applied, its calculation does not significantly enhance the clinical performance of PSA alone.