Article Text

Prostate-Specific Antigen ‘Velocity’ as a Diagnostic Test for Prostate Cancer
  1. John Concato,
  2. Carolyn K. Wells
  1. From Department of Medicine, the Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT, and Yale University School of Medicine, New Haven, CT.
  1. Grant funding was received from the Epidemiology Research Program, US Department of Veterans Affairs.
  2. Address correspondence to: Dr. John Concato, VA Connecticut Healthcare Systems, Clinical Epidemiology Research Center, 950 Campbell Avenue, 151B, West Haven, CT 06516; e-mail: john.concato{at}


Background Prostate-specific antigen “velocity” (slope) is promoted as a diagnostic test for prostate cancer, but its clinical usefulness is uncertain. Accordingly, we evaluated the sensitivity of prostate-specific antigen (PSA) velocity among men who are diagnosed subsequently with prostate cancer.

Methods Among 64,545 men receiving primary care at any of nine Veterans Affairs Medical Centers during 1989-1990, 1,313 men at least 50 years old had an incident diagnosis of prostate cancer during 1991-1995. PSA velocity values obtained prior to diagnosis (“test”) were compared with results from prostate biopsies (“truth”).

Results Among men (n = 493) with at least two tests before diagnosis, the sensitivity of PSA velocity ≥ 0.75 ng/mL/yr was 75.5% (95% confidence interval [CI] 71.7-79.3) overall and 48.1% (95% CI 34.8-61.5) among men with normal values of PSA (< 4.0 ng/mL). Based on published data for specificity and prevalence, the estimated positive predictive value of PSA velocity ≥ 0.75 ng/mL/yr is as low as 5%.

Conclusion PSA velocity may have limited usefulness as a diagnostic test for prostate cancer.

Key words
  • prostatic neoplasms
  • prostate-specific antigen
  • mass screening

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