UNIVERSITY OF CALGARY

UNIVERSITY OF CALGARY
Prostate Specific Antigen Testing and Prostate Specific Antigen Velocity for the Screening of
Prostate Cancer
by
William Wayne Gorday
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF SCIENCE
GRADUATE PROGRAM IN MEDICAL SCIENCE
CALGARY, ALBERTA
MAY, 2015
© William Wayne Gorday 2015

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Abstract
Prostate specific antigen (PSA) testing for the screening of prostate cancer is
controversial with medical and governmental organizations issuing contradictory statements
regarding its use. My research looked at the utilization of the PSA test for the screening of
prostate cancer in Calgary, Alberta for 2011 and if sociodemographic factors influenced the rate
of testing. I studied whether PSA velocity is better than a single PSA test in predicting prostate
biopsy outcome and if sub-dividing Gleason score 7 prostate cancers improves the predictive
ability of PSA tests. My research found that PSA testing does not follow official guidelines in
younger men and that certain sociodemographic factors do influence the rate of PSA testing. I
found that PSA velocity is not better than the PSA test in predicting prostate biopsy diagnosis
and that sub-dividing Gleason score 7 prostate cancers can increase the clinical utility of the PSA
test.

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Preface
The following publications and presentation are based on work found in the thesis.
1. Gorday W, Sadrzadeh H, de Koning L, Naugler C. Association of sociodemographic
factors and prostate-specific antigen (PSA) testing. Clinical Biochemistry, 2014.
2. Gorday W, Sadrzadeh H, de Koning L, Naugler C. Prostate-specific antigen velocity
is not better than total prostate-specific antigen in predicting prostate biopsy
diagnosis. Submitted to Clinical Biochemistry
3. Gorday W, Sadrzadeh H, de Koning L, Naugler C. Association of sociodemographic
factors and prostate-specific antigen testing. Poster presentation, University of
Pathology, Department of Pathology and Laboratory Medicine Annual Residents‟ &
Graduate Students‟ Research Day, 07 Nov 2014.

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Acknowledgements
I would like to thank my thesis committee members Dr. Christopher Naugler, Dr.
Lawrence deKoning and Dr. Hossein Sadrzadeh for their time and effort in ensuring the success
of this thesis. Specifically I would like to acknowledge my thesis supervisor Dr. Christopher
Naugler, whose original ideas, guidance and support made this project possible. I would also like
to thank Calgary Laboratory Services, Dr. Jim Wright and Dr.Amy Bromley for creating and
supporting the Pathologists‟ Assistant program.

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Table of Contents
Abstract .......................................................................................................................... 1
Preface ............................................................................................................................ 2
Acknowledgements ......................................................................................................... 3
Table of Contents ............................................................................................................ 4
List of Tables .................................................................................................................. 6
List of Figures and Illustrations ....................................................................................... 7
List of Symbols, Abbreviations and Nomenclature .......................................................... 8
CHAPTER ONE: INTRODUCTION .............................................................................. 9
1.1 Production and Function of Prostate Specific Antigen ........................................... 9
1.2 Background of Prostate Specific Antigen Testing ................................................ 10
1.3 Findings of the Prostate, Colorectal and Ovarian Cancer trial and the European
Randomised Study of Screening for Prostate Cancer .......................................... 12
1.3.1 Limitations of the Prostate, Colorectal and Ovarian Cancer trial and the European
Randomised Study of Screening for Prostate Cancer .................................... 14
1.4 Recommendations Regarding Prostate Specific Antigen Testing ......................... 16
1.5 Background of Prostate Specific Antigen Velocity .............................................. 17
1.6 Recommendations Regarding Use of Prostate Specific Antigen Velocity ............. 19
1.7 Prostate Cancer Statistics ..................................................................................... 20
1.8 Research significance and Contributions.............................................................. 21
CHAPTER TWO: ASSOCIATION OF SOCIODEMOGRAPHIC FACTORS AND
PROSTATE-SPECIFIC ANTIGEN (PSA) TESTING .......................................... 24
2.1 Introduction ......................................................................................................... 24
2.2 Methods .............................................................................................................. 26
2.2.1 Ethics statement .......................................................................................... 26
2.2.2 Study population and data sources ............................................................... 26
2.2.3 Statistical Analysis ...................................................................................... 27
2.3 Results ................................................................................................................ 28
2.4 Discussion ........................................................................................................... 40
2.5 Conclusion .......................................................................................................... 44
CHAPTER THREE: PROSTATE-SPECIFIC ANTIGEN VELOCITY IS NOT BETTER
THAN TOTAL PROSTATE-SPECIFIC ANTIGEN IN PREDICTING PROSTATE
BIOPSY DIAGNOSIS. ........................................................................................ 45
3.1 Introduction ......................................................................................................... 45
3.2 Methods .............................................................................................................. 47
3.2.1 Ethics statement .......................................................................................... 47
3.2.2 Study population and data sources ............................................................... 47
3.2.3 Statistical Analysis ...................................................................................... 48
3.3 Results ................................................................................................................ 50