Using the free-to-total prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels

Hoffman, Richard M.; Clanon, David L.; Littenberg, Benjamin; Frank, Joseph J.; Peirce, John C.

doi:10.1046/j.1525-1497.2000.90907.x

Cited by 49 publications

(28 citation statements)

References 106 publications

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“…In a systematic review [24] , a %fPSA 1 25% in men with PSA between 4.0 and 9.9 ng/ ml avoided about 20% of the biopsies, allowing 8% of the cancers to be missed. In the PSA range of 2.0-3.9 ng/ml, %fPSA demonstrated a greater diagnostic accuracy than other modalities proposed to enhance PSA perfomance (PSA velocity, PSA density, transition zone density) [6] .…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Significance of Prostate Cancer among 12,682 Men with Normal Digital Rectal Examination, Low PSA Levels (≤4 ng/ml) and Percent Free PSA Cutoff Values of 15 and 20%

Pepe

Panella²,

Savoca³

et al. 2007

Urol Int

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Aim: To report prevalence and clinical relevance of T1c prostate cancers (PCa) in a selected population of men with serum prostate-specific antigen (PSA) levels ≤4 ng/ml enrolled in a multicenter case-finding protocol. Patients andMethods: A number of 16,298 men, aged 40–75 years, from the urology units they had been referred to, in most cases (81.6%) for lower urinary tract symptoms, were evaluated. Eighty percent of them had PSA ≤4 ng/ml and about 40% PSA ≤2.5 ng/ml. Patients with PSA ≤2.5 ng/ml and PSA between 2.6 and 4 ng/ml and with percent free PSA ≤15 and ≤20%, respectively, were eligible for biopsy; 28 patients refused it, and 11 patients were excluded from the study because of an abnormal digital rectal examination. Among 403 biopsied men, 82 had PSA ≤2.5 ng/ml (group A) and 321 PSA between 2.6 and 4 ng/ml (group B). Results: A PCa was found in 109 cases (27.0%): 21 in group A and 88 in group B. 48 (44%) of the 109 patients with a PCa underwent radical prostatectomy: all cancers had a volume >0.5 cm³, and 41% had a final Gleason sum ≧7; the PCa was organ confined in 34 patients (70.8%) and locally advanced in 14 patients (29.1%), and in 12 patients (25%) positive surgical margins were found. Conclusions: Using percent free PSA thresholds of 15 and 20%, 25.6% of the men with PSA ≤2.5 ng/ml and 27.4% of the men with PSA between 2.6 and 4 ng/ml were found to have a PCa, respectively. Most of these cancers, when submitted to radical prostatectomy, were found to be clinically significant. As these cancers are mostly organ confined, these patients are ideal candidates for curative nerve-sparing surgery.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Significance of Prostate Cancer among 12,682 Men with Normal Digital Rectal Examination, Low PSA Levels (≤4 ng/ml) and Percent Free PSA Cutoff Values of 15 and 20%

Pepe

Panella²,

Savoca³

et al. 2007

Urol Int

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“…Maximizes sensitivity: the cutpoint c maximizing Se(c) (Filella et al 1995;Hoffman, Clanon, Littenberg, Frank, and Peirce 2000;Álvarez García et al 2003).…”

Section: Maxsementioning

confidence: 99%

OptimalCutpoints: AnRPackage for Selecting Optimal Cutpoints in Diagnostic Tests

López-Ratón¹,

et al. 2014

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Continuous diagnostic tests are often used for discriminating between healthy and diseased populations. For the clinical application of such tests, it is useful to select a cutpoint or discrimination value c that defines positive and negative test results. In general, individuals with a diagnostic test value of c or higher are classified as diseased. Several search strategies have been proposed for choosing optimal cutpoints in diagnostic tests, depending on the underlying reason for this choice. This paper introduces an R package, known as OptimalCutpoints, for selecting optimal cutpoints in diagnostic tests. It incorporates criteria that take the costs of the different diagnostic decisions into account, as well as the prevalence of the target disease and several methods based on measures of diagnostic test accuracy. Moreover, it enables optimal levels to be calculated according to levels of given (categorical) covariates. While the numerical output includes the optimal cutpoint values and associated accuracy measures with their confidence intervals, the graphical output includes the receiver operating characteristic (ROC) and predictive ROC curves. An illustration of the use of OptimalCutpoints is provided, using a real biomedical dataset.

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“…Berger 17 Devillé 18 Fiellin 19 * Gould 20 * Hobby 21 Hoffman 22 Hoogendam 23 * Huicho 24 Hurley 25 Kelly 26 Kim 27 * Kwok 28 Balk 15 and Lau 16 Lederle 29 Mitchell 30 * Mol 31 * Nelemans 32 Safriel 33 * Sloan 34 Sonnad 35 Vasquez 36 Visser 37 *…”

Section: Specificity Sensitivitymentioning

confidence: 99%

Variation of a test’s sensitivity and specificity with disease prevalence

Leeflang

Rutjes

Reitsma

et al. 2013

CMAJ

425

315

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Research CMAJBackground: Anecdotal evidence suggests that the sensitivity and specificity of a diagnostic test may vary with disease prevalence. Our objective was to investigate the associations between disease prevalence and test sensitivity and specificity using studies of diagnostic accuracy. Methods:We used data from 23 meta-analyses, each of which included 10-39 studies (416 total). The median prevalence per review ranged from 1% to 77%. We evaluated the effects of prevalence on sensitivity and specificity using a bivariate random-effects model for each metaanalysis, with prevalence as a covariate. We estimated the overall effect of prevalence by pooling the effects using the inverse variance method.Results: Within a given review, a change in prevalence from the lowest to highest value resulted in a corresponding change in sensitivity or specificity from 0 to 40 percentage points. This effect was statistically significant (p < 0.05) for either sensitivity or specificity in 8 metaanalyses (35%). Overall, specificity tended to be lower with higher disease prevalence; there was no such systematic effect for sensitivity. Interpretation:The sensitivity and specificity of a test often vary with disease prevalence; this effect is likely to be the result of mechanisms, such as patient spectrum, that affect prevalence, sensitivity and specificity. Because it may be difficult to identify such mechanisms, clinicians should use prevalence as a guide when selecting studies that most closely match their situation. Abstract

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Using the free-to-total prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels

Abstract: BACKGROUND: Prostate-specific antigen (PSA) levels between 4.0 to 10.0 ng/ml have poor specificity in prostate cancer screening, leading to unnecessary biopsies.

Cited by 49 publications

References 106 publications

Prevalence and Clinical Significance of Prostate Cancer among 12,682 Men with Normal Digital Rectal Examination, Low PSA Levels (≤4 ng/ml) and Percent Free PSA Cutoff Values of 15 and 20%

Prevalence and Clinical Significance of Prostate Cancer among 12,682 Men with Normal Digital Rectal Examination, Low PSA Levels (≤4 ng/ml) and Percent Free PSA Cutoff Values of 15 and 20%

OptimalCutpoints: AnRPackage for Selecting Optimal Cutpoints in Diagnostic Tests

Variation of a test’s sensitivity and specificity with disease prevalence

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