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
. 2009 Sep 24:339:b3537.
doi: 10.1136/bmj.b3537.

Prostate specific antigen for early detection of prostate cancer: longitudinal study

Benny Holmström  1 , Mattias Johansson, Anders Bergh, Ulf-Håkan Stenman, Göran Hallmans, Pär Stattin
Affiliations

Prostate specific antigen for early detection of prostate cancer: longitudinal study

Benny Holmström et al. BMJ. .

Abstract

Objective: To evaluate if prostate specific antigen test attains validity standards required for screening in view of recent prostate cancer screening trial results.

Design: Case-control study nested in longitudinal cohort.

Setting: Västerbotten Intervention Project cohort, Umeå, Sweden.

Participants: 540 cases and 1034 controls matched for age and date of blood draw.

Main outcome measure: Validity of prostate specific antigen for prediction of subsequent prostate cancer diagnosis by record linkage to cancer registry.

Results: Blood samples were drawn on average 7.1 (SD 3.7) years before diagnosis. The area under the curve for prostate specific antigen was 0.84 (95% confidence interval 0.82 to 0.86). At prostate specific antigen cut-off values of 3, 4, and 5 ng/ml, sensitivity estimates were 59%, 44%, and 33%, and specificity estimates were 87%, 92%, and 95%. The positive likelihood ratio commonly considered to "rule in disease" is 10; in this study the positive likelihood ratios were 4.5, 5.5, and 6.4 for prostate specific antigen cut-off values of 3, 4, and 5 ng/ml. The negative likelihood ratio commonly considered to "rule out disease" is 0.1; in this study the negative likelihood ratios were 0.47, 0.61, and 0.70 for prostate specific antigen cut-off values of 3, 4, and 5 ng/ml. For a cut-off of 1.0 ng/ml, the negative likelihood ratio was 0.08.

Conclusions: No single cut-off value for prostate specific antigen concentration attained likelihood ratios formally required for a screening test. Prostate specific antigen concentrations below 1.0 ng/ml virtually ruled out a prostate cancer diagnosis during the follow-up. Additional biomarkers for early detection of prostate cancer are needed before population based screening for prostate cancer should be introduced.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None declared.

Figures

None
Fig 1 Distribution of plasma prostate specific antigen (PSA) concentrations in cases and controls. Curves indicate frequency functions of calculated normal distribution of logarithm of PSA concentrations according to mean and standard deviation in cases and controls. Histogram shows observed distribution of logarithm of PSA concentrations in cases and controls
None
Fig 2 Fagan’s nomogram for calculation of post-test probabilities. Blue (solid) arrows indicate post-test probability of diagnosis during follow-up for men with prostate specific antigen (PSA) concentrations above given cut-offs. Red (broken) arrows indicate post-test probability of diagnosis during follow-up for men with PSA concentrations below given cut-offs
See this image and copyright information in PMC

Comment in

References

    1. Ross KS, Carter HB, Pearson JD, Guess HA. Comparative efficiency of prostate-specific antigen screening strategies for prostate cancer detection. JAMA 2000;284:1399-405. - PubMed
    1. Yao SL, Lu-Yao G. Interval after prostate specific antigen testing and subsequent risk of incurable prostate cancer. J Urol 2001;166:861-5. - PubMed
    1. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues. CA Cancer J Clin 2008;58:161-79. - PubMed
    1. Lieberman R. Evidence-based medical perspectives: the evolving role of PSA for early detection, monitoring of treatment response, and as a surrogate end point of efficacy for interventions in men with different clinical risk states for the prevention and progression of prostate cancer. Am J Ther 2004;11:501-6. - PubMed
    1. Stenman UH, Abrahamsson PA, Aus G, Lilja H, Bangma C, Hamdy FC, et al. Prognostic value of serum markers for prostate cancer. Scand J Urol Nephrol Suppl 2005;216:64-81. - PubMed

Publication types

Substances