Systematic review of pretreatment XXXX velocity and doubling time as predictors for @entity263 .

@entity1 @entity263 @entity5 @entity3 @entity1486
PURPOSE: Pretreatment @entity1486 (PSA) dynamics (PSA velocity and PSA doubling time) are widely advocated as useful prognostic markers in @entity263 . We aimed to assess the published evidence for the clinical utility of PSA dynamics in this population. METHODS: We conducted a systematic review of studies published before March 2007 in which a PSA dynamic (velocity or doubling time) was calculated in @entity1 before definitive treatment, a subsequent event (such as biopsy or recurrence) was ascertained, and the association between the two was analyzed. Our principal end point was the type of analysis reported, particularly whether the predictive accuracy of a statistical model that included both absolute PSA level and a PSA dynamic was compared with that of a model that included only PSA. RESULTS: Eighty-seven articles were eligible for analysis. The most common end points were biopsy (42 articles), and either recurrence (14 articles) or @entity3 or death (14 articles) after definitive therapy. Although PSA dynamics were generally found to be associated with outcome, only one article compared predictive accuracy of models with and without a PSA dynamic: this reported that PSA velocity improved prediction slightly (from 0.81 to 0.83), but was subject to verification bias. No article used decision analytic methods to examine the clinical impact of PSA dynamics. CONCLUSION: There is little evidence that calculation of PSA velocity or doubling time in untreated @entity1 provides predictive information beyond that provided by absolute PSA level alone. We see no justification for the use of PSA dynamics in clinical decision making before treatment in @entity5 .
