Prostate specific antigen for early detection of prostate cancer: longitudinal study.
OBJECTIVE
To evaluate if prostate specific antigen test attains validity standards required for screening in view of recent prostate cancer screening trial results.


METHODS
Case-control study nested in longitudinal cohort.


METHODS
Västerbotten Intervention Project cohort, Umeå, Sweden.


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


METHODS
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.
Department of Surgery, Gävle Hospital, S-801 87 Gävle, Sweden.
Benny
B
Holmström
Mattias
M
Johansson
Anders
A
Bergh
Ulf-Håkan
UH
Stenman
Göran
G
Hallmans
Pär
P
Stattin
D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary; D016022:Case-Control Studies; D055088:Early Detection of Cancer; D006801:Humans; D008137:Longitudinal Studies; D008207:Lymphatic Metastasis; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen