Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2000 Oct;15(10):739-48.
doi: 10.1046/j.1525-1497.2000.90907.x.

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

R M Hoffman  1 , D L Clanon, B Littenberg, J J Frank, J C Peirce
Affiliations
Meta-Analysis

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

R M Hoffman et al. J Gen Intern Med. 2000 Oct.

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.

Objective: To determine whether the free-to-total PSA ratio (F/T PSA) improved the diagnostic accuracy of these nonspecific PSA levels.

Measurements and main results: MEDLINE searchedwas from 1986 to 1997. Additional studies were identified from article bibliographies and by searching urology journals. Two investigators independently identified English-language studies providing F/T PSA ratio test-operating characteristics data on > or = 10 cancer patients with PSA values between 2.0 and 10.0 ng/ml. Twenty-one of 90 retrieved studies met selection criteria. Two investigators independently extracted data on methodology and diagnostic performance. Investigator-selected cut points for the optimal F/T PSA ratio had a median likelihood ratio of 1.76 (interquartile range, 1.40 to 2.11) for a positive test and 0.27 (0.20 to 0.40) for a negative test. Assuming a 25% pretest probability of cancer, the posttest probabilities were 37% following a positive test and 8% following a negative test. The summary receiver operating characteristic curve showed that maintaining test sensitivity above 90% was associated with false positive rates of 60% to 90%. Methodologic problems limited the validity and generalizability of the literature.

Conclusions: A negative test reduced the posttest probability of cancer to approximately 10%. However, patients may find that this probability is not low enough to avoid undergoing prostate biopsy. The optimal F/T PSA ratio cut point and precise estimates for test specificity still need to be determined.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Investigator-selected cut points for the free-to-total PSA ratio are plotted against the posttest probabilities for positive and negative tests. Curves are based on a pretest probability of 25%.
FIGURE 2
FIGURE 2
The estimated summary receiver operating characteristic curve based on the 17 studies presenting data on investigator-selected cut points for the free-to-total PSA ratio.
See this image and copyright information in PMC

Comment in

References

    1. Mettlin C, Jones G, Averette H, Gusberg SB, Murphy GP, et al. Defining and updating the American Cancer Society guidelines for the cancer related check-up: prostate and endometrial cancers. CA Cancer J Clin. 1993;43:42–6. - PubMed
    1. American Urological Association. Early detection of prostate cancer and use of transrectal ultrasound. American Urological Association 1992 Policy Statement Book. Baltimore, Md: Williams & Wilkins; 1992.
    1. PDQ. (Physician Data Query) [database online]. Bethesda, Md: National Cancer Institute: 1984 – [updated 9/99]. Screening for prostate cancer. Available from: National Cancer Institute; National Library of Medicine, Bethesda, Md: CDP Technologies, Inc., New York, NY; Lexis-Nexis, Miamisburg, Ohio.
    1. American College of Physicians. Screening for prostate cancer. Ann Intern Med. 1997;126:480–4. - PubMed
    1. U.S. Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore: Williams & Wilkins; 1996.

Publication types

Substances