Meta-Analysis of Prostate-Specific Antigen and Digital Rectal Examination as Screening Tests for Prostate Carcinoma

Mistry, Kishor; Cable, Greg

doi:10.3122/jabfm.16.2.95

Cited by 205 publications

(139 citation statements)

References 32 publications

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“…[28][29][30][31] and neither test has high sensitivity (72.1% and 53.2%, respectively; ref. 32). Some believe that the increasing PSA level is the most informative (33).…”

Section: Discussionmentioning

confidence: 99%

Family History, Perceived Risk, and Prostate Cancer Screening among African American Men

Bloom

Stewart

Oakley-Girvans

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Many African American men have two major risk factors for prostate cancer. By ethnicity alone, they have twice the risk of Euro-American men of developing prostate cancer. Having a family history (brother or father with prostate cancer) also doubles their risk. The major hypotheses tested in this study are that men with a family history perceive their risk to be higher, are more worried about getting prostate cancer, and are more likely to have used cancer screening tests than men without such a history. Methods: A sample of 208 African American men, ages 40 to 74 years, were recruited through relatives or friends whose prostate cancer diagnosis was reported to the California Cancer Registry during the years 1997 to 2001 and from churches and African American social groups. Following a screening interview to determine eligibility, 88 men with self-reported, first-degree family history of prostate cancer

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“…[28][29][30][31] and neither test has high sensitivity (72.1% and 53.2%, respectively; ref. 32). Some believe that the increasing PSA level is the most informative (33).…”

Section: Discussionmentioning

confidence: 99%

Family History, Perceived Risk, and Prostate Cancer Screening among African American Men

Bloom

Stewart

Oakley-Girvans

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…However, PSA has severe limitations as a screening test. First, PSA has a low specificity, and its positive predictive value is only approximately 25% in a pooled metaanalysis (3 ), leading to a large number of false-positive results and up to 75% of unnecessary prostate biopsies (4 ). Second, PSA lacks sensitivity, because up to 30% of PCa cases and among these 10% of aggressive PCa cases can be identified in patients with a PSA below 4 g/L (5 ).…”

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confidence: 99%

Multicenter Evaluation of [−2]Proprostate-Specific Antigen and the Prostate Health Index for Detecting Prostate Cancer

et al. 2013

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BACKGROUND Total prostate-specific antigen (tPSA) is flawed for prostate cancer (PCa) detection. [−2]proprostate-specific antigen (p2PSA), a molecular isoform of free PSA (fPSA), shows higher specificity compared with tPSA or percentage of free PSA (%fPSA). The prostate health index (Phi), a measure based on p2PSA and calculated as p2PSA/fPSA × √tPSA, was evaluated in a multicenter study for detecting PCa. METHODS A total of 1362 patients from 4 different study sites who had tPSA values of 1.6–8.0 μg/L (668 patients with PCa, 694 without PCa) underwent ≥10 core biopsies. Serum concentrations of tPSA, fPSA (both calibrated against a WHO reference material), and p2PSA were measured on Access2 or DxI800 analyzers (Beckman Coulter). RESULTS The percentage ratio of p2PSA to fPSA (%p2PSA) and Phi were significantly higher in all PCa subcohorts (positive initial or repeat biopsy result or negative digital rectal examination) (P < 0.0001) compared with patients without PCa. Phi had the largest area under the ROC curve (AUC) (AUC = 0.74) and provided significantly better clinical performance for predicting PCa compared with %p2PSA (AUC = 0.72, P = 0.018), p2PSA (AUC = 0.63, P < 0.0001), %fPSA (AUC = 0.61) or tPSA (AUC = 0.56). Significantly higher median values of Phi were observed for patients with a Gleason score ≥7 (Phi = 60) compared with a Gleason score <7 (Phi = 53; P = 0.0018). The proportion of aggressive PCa (Gleason score ≥7) increased with the Phi score. CONCLUSIONS The results of this multicenter study show that Phi, compared with tPSA or %fPSA, demonstrated superior clinical performance in detecting PCa at tPSA 1.6–8.0 μg/L (i.e., approximately 2–10 μg/L in traditional calibration) and is better able to detect aggressive PCa.

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“…A volunteer-based study in the US reported specificity of 73% (Punglia et al, 2005). A meta-analysis estimated specificity of PSA as 93% at 4.0 ng ml À1 (Mistry and Cable, 2003). Our study population may represent relatively low-risk men, as the trial is population-based and the subjects are fairly young.…”

Section: Discussionmentioning

confidence: 99%

Specificity of serum prostate-specific antigen determination in the Finnish prostate cancer screening trial

et al. 2007

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Specificity constitutes a component of validity for a screening test. The number of false-positive (FP) results has been regarded as one of major shortcomings in prostate cancer screening. We estimated the specificity of serum prostate-specific antigen (PSA) determination in prostate cancer screening using data from a randomised, controlled screening trial conducted in Finland with 32 000 men in the screening arm. We calculated the specificity as the proportion of men with negative findings (screen negatives, SN) relative to those with negative and FP results (SN/(SN þ FP)). A SN finding was defined as either PSAp4 ng ml À1 or PSA 3.0 -3.9 ng ml À1 combined with a negative ancillary test (digital rectal examination, DRE or free/total, F/T PSA ratio). False positives were those with positive screening test followed by a negative diagnostic examination. Of the 30 194 eligible men, 20 794 (69%) attended the first screening round and 1968 (9.5%) had a screen-positive finding. A total of 508 prostate cancers were detected at screening (2.4%). Hence, the number of SN findings was 18 825 and the number of FP results 1358. Specificity was estimated as 0.933 (18 825 out of 20 183) with 95% confidence interval (CI) 0.929 -0.936. Specificity decreased with age. Digital rectal examination as ancillary examination had similar or higher specificity than F/T PSA. In the second screening round, specificity was slightly lower (0.912, 95% CI 0.908 -0.916). The specificity of PSA screening in the Finnish screening trial is acceptable. Further improvement in specificity could, however, improve acceptability of screening and decrease screening costs.

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Meta-Analysis of Prostate-Specific Antigen and Digital Rectal Examination as Screening Tests for Prostate Carcinoma

Cited by 205 publications

References 32 publications

Family History, Perceived Risk, and Prostate Cancer Screening among African American Men

Family History, Perceived Risk, and Prostate Cancer Screening among African American Men

Multicenter Evaluation of [−2]Proprostate-Specific Antigen and the Prostate Health Index for Detecting Prostate Cancer

Specificity of serum prostate-specific antigen determination in the Finnish prostate cancer screening trial

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