The performance of prostate specific antigen for predicting prostate cancer is maintained after a prior negative prostate biopsy.
OBJECTIVE
It has been suggested that prostate specific antigen has no predictive value for prostate cancer after a first negative biopsy has been performed. We compared the performance operating characteristics of prostate specific antigen for prostate cancer between a first and subsequent prostate biopsy in a group of men with complete verification of cancer status.


METHODS
From the 18,882 participants in the Prostate Cancer Prevention Trial we examined men in the placebo group who had only a first biopsy or a first and second prostate biopsy with a prostate specific antigen and digital rectal examination within 1 year before each biopsy. The receiver operating characteristic curve was estimated for prostate specific antigen for detection of prostate cancer on the first biopsy compared to the second, and the C-statistics were compared.


RESULTS
Of this group 5,608 men had a first biopsy and 687 of those with a negative first biopsy underwent a second biopsy. The C-statistic was 0.650 (95% CI 0.632, 0.668) for the first biopsy and 0.664 (95% CI 0.607, 0.721) for the second biopsy. The C-statistic for the second biopsy was statistically significantly greater than 0.5 (p <0.001) and overlapped with that from the first biopsy.


CONCLUSIONS
Prostate specific antigen does not lose predictive value for the detection of prostate cancer even after a first biopsy shows no evidence of cancer, and its performance characteristics are only slightly decreased.
University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. thompsoni@uthscsa.edu
Ian M
IM
Thompson
Catherine M
CM
Tangen
Donna P
DP
Ankerst
Chen
C
Chi
M Scott
MS
Lucia
Phyllis
P
Goodman
Howard
H
Parnes
Charles A
CA
Coltman
D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001707:Biopsy, Needle; D016001:Confidence Intervals; D051517:Digital Rectal Examination / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology*; D012372:ROC Curve; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen