Prostate-specific antigen change in the European Randomized Study of Screening for Prostate Cancer, section Rotterdam.

Objectives: To determine the prostate-specific antigen (PSA) velocity, PSA slope, and PSA doubling time (PSADT) in men with positive biopsies, negative biopsies, and no biopsy indications 4 years after an initial screening; and to use this information to improve the test characteristics in the early detection of prostate cancer and provide normal values for these parameters in screened men with and without evidence of prostate cancer.

Methods: Within the European Randomized Study of Screening for Prostate Cancer, section Rotterdam, we identified 9575 men with a second determination of PSA 4 years after the initial screening. These men were divided into three groups: men with positive biopsies, negative biopsies, and no biopsy indications in the second round (PSA less than 3.0 ng/mL). The predictive values of PSA dynamics for detection of prostate cancer were calculated.

Results: The mean PSA velocity of men with prostate cancer was 0.62 ng/mL/yr versus 0.46 ng/mL/yr for men with a negative biopsy (P = 0.001). The mean PSADT for men with prostate cancer was 5.1 years and for those with a negative biopsy it was 6.1 years (P = 0.002). The PSADT for men with no indication for biopsy was 25.1 years. However, receiver operating characteristic analyses revealed only a moderate value for these test parameters in predicting biopsy outcome.

Conclusions: The mean values of PSA velocity, PSA slope, and PSADT in a rescreened population differed significantly between men with and without prostate cancer. However, in predicting the biopsy outcome, the PSA dynamics were of limited value.