Prostate-Specific Antigen as a Screening Test for Prostate Cancer

Arcangeli, Carlos G.; Ornstein, David K.; Keetch, David W.; Andriole, Gerald L.

doi:10.1016/s0094-0143(05)70376-1

Cited by 75 publications

(36 citation statements)

References 61 publications

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“…The combination of tPSA cutoff in 2.5 ng/ml associated to additional criteria for indication of biopsy, such as free/total PSA ratio in 20% or PSAD in 0.08, seemed to represent a better option than employing only tPSA in all other cut-off levels. In the literature, results are controversial and there is no agreement about the best cut-off level for tPSA, as well as about the benefits gained with the associated use of the free/total PSA ratio and tPSA density, but one can note a tendency towards recommending a reduction in the cut-off level of tPSA and applying associated parameters in order to improve the test specificity (4,6). Maybe the most convincing recent multiracial study about the subject involving the screening and the follow-up of 12,902 men, of whom 7,541 were considered without prostate disease, showed that 95% of the sample without disease had tPSA ≤ 2.45 ng/ml, and this is the reason why this value was proposed as the upper limit for normality (19).…”

Section: Discussionmentioning

confidence: 99%

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Racial influence on the prevalence of prostate carcinoma in Brazilian volunteers

et al. 2003

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Purpose: To investigate the prevalence of prostate carcinoma in a sample of volunteers known to have a large proportion of Bantu African ancestors, and the performance of total PSA (tPSA), PSA density (PSAD) and free-to-total PSA ratio (f/tPSA) on the diagnosis.Materials and Methods: A total of 473 volunteers (range: 40 -79 years) were screened for prostate carcinoma. Those with tPSA >2 ng/ml and/or abnormal digital rectal examination were submitted to a transrectal ultrasound-directed biopsy (10 cores). The volunteers were classified as White, Mulatto or Black according to physical characteristics and to ancestors race reference. The following variable number of tandem repeats (VNTR) were analyzed in the blood of 120 volunteers without cancer and in 27 patients with prostate cancer: D4S43, PAH, F13A1, APOB and vW-1.Results: The biopsies performed in 121 volunteers revealed cancer in 27 (5.7% of 473). The proportions of cancer in White, Mulatto and Black were respectively: 0.6% (1/148), 6.7% (6/90) and 8.5% (20/235) (p = 0.006). The VNTRs analysis revealed heterogeneity in White, Mulatto and Black anthropologic phenotypes with the following admixture of Caucasian, African and Amerindian gene lineages: 67.5 ± 8%, 20.8 ± 8%, 11.7 ± 7%; 54.8 ± 9%, 36.3 ± 5%, 8.9 ± 7%; and, 45.3 ± 3%, 45.9 ± 4%, 8.8 ± 7%. Such a mixture was 50.5 ± 9%, 49 ± 8% and 0.5 ± 4% in volunteers bearing cancer, and 59.1 ± 7%, 31.7 ± 8% and 9.2 ± 5% in those without cancer. The sensitivity and specificity of tPSA at cut-off levels of 2, 2.5 and 4 ng/ml for volunteers with tPSA ≤ 10 ng/ml were respectively: 100% and 6,6%, 100% and 36,6%, 69,2% and 62,2%. PSAD at a cut-off level of 0.08 or 0.10, and f/tPSA at a cut-off level of 20% were able to increase significantly tPSA specificity without loss on sensitivity.Conclusions: The tumor prevalence was higher in Non-White than in White phenotype. The association of tPSA at a cut-off level of 2.5 ng/ml with a PSAD of 0.08 or a f/tPSA of 20% for biopsy indication deserves further investigations as an alternative to tPSA cut-off level of 4 ng/ml.

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Section: Discussionmentioning

confidence: 99%

“…There are studies showing that in the tPSA range between 2.5 and 4 ng/ml the prevalence of cancer reaches 24%, and that is why many centers started to recommend this cut-off level for indication of biopsy (6).…”

Section: Introductionmentioning

confidence: 99%

Racial influence on the prevalence of prostate carcinoma in Brazilian volunteers

et al. 2003

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“…a diagnosis of PCa (Arcangeli et al, 1997). A large number of men face the prospect of prostate biopsy with limited information about their likelihood of harboring PCa.…”

Section: Introductionmentioning

confidence: 99%

Potential predictive factors of positive prostate biopsy in the Chinese population

Li¹,

Tang²,

Li³

et al. 2012

Afr. J. Biotechnol.

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There are numerous arguments for the predictive factors of positive prostate biopsies differing according to race and region. This retrospective study aimed to determine predictive factors for a positive prostate biopsy in Chinese men. Data were collected from 1608 men who underwent a prostate biopsy for suspected prostate cancer. Variables analyzed included age, prostate specific antigen (PSA) level, prostate volume and PSA density (PSAD). Logistic regression analysis estimated relative risk, 95% confidence intervals and p values. Overall, 598 (37.19%) of the 1608 biopsied had prostate cancer. Independent predictors of a positive biopsy result include advanced age, elevated PSA levels, small prostate volume and increased PSAD. Our study showed significant predictors for positive prostate biopsy in Chinese men and a combination of age, PSA, prostate volume and PSAD better defined the probability of a positive biopsy than any factor alone. In the future, we may be able to use our finding to create a nomogram for predicting positive prostate biopsy in Chinese men.

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“…But, other studies show that PSAD has no value for such discrimination 5 . Others recommend the PSAD at the cut-off level of 0,15 to make a decision on the indication of a 2 nd set prostate biopsy when the 1 st set gave a negative result 6 . The aim of our study was to investigate the influence of PSAD and prostate volume on the performance of PSA to the diagnosis of prostate carcinoma in a subset of patients (with serum PSA £ 10ng/ml) submitted to prostate biopsy.…”

Section: Introductionmentioning

confidence: 99%

Performance of PSA and of PSA density in the diagnosis of prostate carcinoma

Martins

Bovo

Reis³

et al. 2002

Acta Cir. Bras.

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Objective -The aim of the study was to investigate the influence of the prostate volume and PSA density on the performance of total PSA to diagnosis of prostate carcinoma. Methods -We analyzed 217 patients (PSA 0-10ng/ml) submitted to transrectal sextant prostate biopsy. Criteria for biopsy indication was PSA >2ng/ml and/or digital rectal exam suspicious of prostate cancer. Results -Fifty five patients had prostate neoplasia (25.3%) and in 8/55 (25.3%) the serum PSA was under 4ng/ml. The sensitivity and specificity of the test were respectively 98.2% / 16.6% at a cut-off point of 2.5ng/ml and 85.4% / 38.8% at cut-off of 4ng/ml. The corresponding values for prostates >40ml or <40ml were: 96.2% / 8.1% and 100% / 27.2% at the cut-off point of 2.5ng/ml, and 92.5% / 20% and 78.5% / 62.3% at a cut-off level of 4ng/ml. For prostates <40ml a PSA cut-off point of 4ng/ml leads to a misdiagnosis in 21.4% of the malignant tumors. The median PSAD of benign prostates are different according to prostate volume (.40ml or <40ml). PSAD at cut-off of 0.08 increases the PSA specificity at both PSA cut-off points. Conclusions -Prostate volume affects the sensitivity and specificity of PSA and the median values of PSAD. PSAD of 0.08 increases the PSA specificity specially at a cut-off point of 2.5ng/ml in prostates smaller than 40ml. Available from URL: http://www.scielo.br/acb

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Prostate-Specific Antigen as a Screening Test for Prostate Cancer

Cited by 75 publications

References 61 publications

Racial influence on the prevalence of prostate carcinoma in Brazilian volunteers

Racial influence on the prevalence of prostate carcinoma in Brazilian volunteers

Potential predictive factors of positive prostate biopsy in the Chinese population

Performance of PSA and of PSA density in the diagnosis of prostate carcinoma

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