Prostate-specific antigen testing accuracy in community practice

Richard M Hoffman; Frank D Gilliland; Meg Adams-Cameron; William C Hunt; Charles R Key

doi:10.1186/1471-2296-3-19

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Prostate-specific antigen testing accuracy in community practice

Journal article

Open access

Peer reviewed

Prostate-specific antigen testing accuracy in community practice

Richard M Hoffman, Frank D Gilliland, Meg Adams-Cameron, William C Hunt and Charles R Key

BMC family practice, Vol.3(1), pp.19-19

10/24/2002

DOI: 10.1186/1471-2296-3-19

PMCID: PMC137591

PMID: 12398793

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Abstract

Background: Most data on prostate-specific antigen (PSA) testing come from urologic cohorts comprised of volunteers for screening programs. We evaluated the diagnostic accuracy of PSA testing for detecting prostate cancer in community practice. Methods: PSA testing results were compared with a reference standard of prostate biopsy. Subjects were 2,620 men 40 years and older undergoing (PSA) testing and biopsy from 1/1/95 through 12/31/98 in the Albuquerque, New Mexico metropolitan area. Diagnostic measures included the area under the receiver-operating characteristic curve, sensitivity, specificity, and likelihood ratios. Results: Cancer was detected in 930 subjects (35%). The area under the ROC curve was 0.67 and the PSA cutpoint of 4 ng/ml had a sensitivity of 86% and a specificity of 33%. The likelihood ratio for a positive test (LR+) was 1.28 and 0.42 for a negative test (LR-). PSA testing was most sensitive (90%) but least specific (27%) in older men. Age-specific reference ranges improved specificity in older men (49%) but decreased sensitivity (70%), with an LR+ of 1.38. Lowering the PSA cutpoint to 2 ng/ml resulted in a sensitivity of 95%, a specificity of 20%, and an LR+ of 1.19. Conclusions: PSA testing had fair discriminating power for detecting prostate cancer in community practice. The PSA cutpoint of 4 ng/ml was sensitive but relatively non-specific and associated likelihood ratios only moderately revised probabilities for cancer. Using age-specific reference ranges and a PSA cutpoint below 4 ng/ml improved test specificity and sensitivity, respectively, but did not improve the overall accuracy of PSA testing.

likelihood functions

Prostatic neoplasms

ROC curve

sensitivity and specificity

prostate-specific antigen

Details

Title: Subtitle: Prostate-specific antigen testing accuracy in community practice
Creators: Richard M Hoffman - Department of Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico, USA
Frank D Gilliland - Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
Meg Adams-Cameron - New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
William C Hunt - New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
Charles R Key - New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
Resource Type: Journal article
Publication Details: BMC family practice, Vol.3(1), pp.19-19
Publisher: BioMed Central
DOI: 10.1186/1471-2296-3-19
PMID: 12398793
PMCID: PMC137591
ISSN: 1471-2296
eISSN: 1471-2296
Language: English
Date published: 10/24/2002
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094483102771

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