Journal article
Using the free-to-total Prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels
Journal of general internal medicine : JGIM, Vol.15(10), pp.739-748
2000
DOI: 10.1046/j.1525-1497.2000.90907.x
PMCID: PMC1495603
PMID: 11089718
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.
Details
- Title: Subtitle
- Using the free-to-total Prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels
- Creators
- Richard M HOFFMAN - Medicine Service, Albuquerque Department of Veterans Affairs Medical Center, Albuquerque, NM, United StatesDavid L CLANON - Medicine Service, Albuquerque Department of Veterans Affairs Medical Center, Albuquerque, NM, United StatesBenjamin LITTENBERG - Department of Medicine, The University of Vermont, Burlington, Vt, United StatesJoseph J FRANK - Department of Medical Education and Research, Good Samaritan Regional Medical Center, Phoenix, Ariz, United StatesJohn C PEIRCE - Department of Medical Education and Research, Good Samaritan Regional Medical Center, Phoenix, Ariz, United States
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.15(10), pp.739-748
- Publisher
- Springer
- DOI
- 10.1046/j.1525-1497.2000.90907.x
- PMID
- 11089718
- PMCID
- PMC1495603
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Language
- English
- Date published
- 2000
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094480902771
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