title: Misclassifying the indications for prostate-specific antigen testing may bias case-control studies of the efficacy of prostate cancer screening.
abstract: OBJECTIVE
  In the absence of data from randomized controlled trials, prostate cancer (CaP) screening recommendations may be based on observational studies that contrast exposure to screening between cases and controls. We evaluated the potential bias from mis-classifying indications for PSA testing in observational studies of CaP screening.
  
  
  METHODS
  We randomly selected men undergoing PSA testing and obtained data on PSA results and prostate biopsies. Data were linked with a tumor registry to identify incident and prevalent cases of CaP. We abstracted medical records for 45 incident cases with CaP and 118 controls without, recording information on lower urinary tract symptoms (LUTS), constitutional symptoms, and digital rectal examination findings. PSA testing was classified as definitely, likely, or possibly screening, or not screening based on clinical history.
  
  
  RESULTS
  Changing the definitions for PSA screening to variably exclude men with LUTS and enlarged prostates differentially lowered the frequency of screening. With more restrictive screening definitions, the odds ratio for screening decreased from 0.47 to 0.07.
  
  
  CONCLUSIONS
  Accurately classifying PSA testing status is difficult because LUTS are common among men targeted for CaP screening. Failing to correctly classify PSA tests may bias study results.
authors.affiliation: Medicine Service, New Mexico VA Health Care System, 111GIM, 1501 San Pedro Drive SE, Albuquerque, NM 87108, USA. rhoffman@unm.edu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Meg L
authors.initials: ML
authors.lastname: Adams-Cameron
authors.forename: Glen H
authors.initials: GH
authors.lastname: Murata
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D015983:Selection Bias; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen