Loughlin Kevin Raymond
Division of Urology, Department of Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Urol Oncol. 2014 Nov;32(8):1116-25. doi: 10.1016/j.urolonc.2014.04.010. Epub 2014 Jun 25.
The 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.
A 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.
The 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.
PSAV 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.
前列腺特异性抗原（PSA）在前列腺癌（CaP）筛查及管理中的价值在医学及大众文献中仍备受争议。本综述旨在批判性分析文献，以评估在CaP筛查及管理中增加PSA速率（PSAV）计算的效用。
对包括Medline PaperChase、PubMed和Scopus在内的电子数据库进行系统综述，以识别1992年至2013年同行评审文献中的英文研究。通过添加以下关键词扩展自由文本搜索：前列腺癌、筛查、手术、放射治疗、主动监测和PSAV。阅读搜索到的所有匹配项，并将与临床实践中PSAV分析相关的文章纳入本综述。
近期许多关于PSAV的已发表文献的设计不符合PSAV的原始描述，也不符合关于PSA值数量及获取PSA值时间间隔的已发表指南。这种定义的异质性是PSAV临床应用诸多争议的根源。大量证据表明，PSA与PSAV之间存在高度共线性，因此PSAV的计算对PSA水平测量的增加作用不大。
许多研究者主张计算PSAV，作为改善CaP患者筛查及临床管理的一种策略。然而，当严格应用PSAV定义时，其计算并不能显著提高单独PSA的临床性能。
