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Interpreting results of prostate-specific antigen testing for early detection of prostate cancer.
J Gen Intern Med 1996; 11(9):505-12JG

Abstract

OBJECTIVE

Calculation of likelihood ratios for serum prostate-specific antigen (PSA) levels to discriminate potentially curable prostate cancer in men selected for having benign prostatic hyperplasia (BPH) or in randomly selected men.

DESIGN

Retrospective analysis of prospectively measured PSA levels.

SETTING

A tertiary referral center, a multicenter randomized controlled trial, and a community-based study, all providing PSA data.

PATIENTS

We used PSA measurements from four groups of men aged 50 to 79 years: 276 men with organ-confined prostate cancer treated with radical prostatectomy, 305 randomly selected men without clinical evidence of prostate cancer or a history of surgery for BPH recruited for a community study, 173 men without cancer but with BPH coming to prostatectomy, and 770 men without cancer and with symptoms of BPH enrolled in the North American finasteride clinical trial.

MEASUREMENTS AND MAIN RESULTS

Age-standardized, stratum-specific likelihood ratios for organ-confined prostate cancer were calculated separately for unselected men in the community sample and for selected men with BPH (pooling both BPH populations). Likelihood ratios ranged from 0.2 for PSA between 0.0 and 2.0 ng/mL to 54.8 for a PSA level of 10.1 ng/mL or higher in unselected men, but rose to only 2.9 for PSA values of 10.1 ng/mL or higher in men with BPH. Forty percent of the men in the community study had moderate to severe lower urinary tract symptoms. In these men, likelihood ratios ranged from 0.2 for PSA values between 0.0 and 2.0 ng/mL to 17.2 for PSA values of 6.1 ng/mL or higher, while in men with no or mild symptoms, likelihood ratios rose to 26.9 for PSA values of 6.1 ng/mL or higher.

CONCLUSIONS

Likelihood ratios for PSA test results allow stratification of men along a continuum of risk for prostate cancer. Likelihood ratios demonstrate that the ability of the PSA test to discriminate potentially curable prostate cancer from BPH is dramatically lower in men selected with lower urinary tract symptoms than in randomly selected men.

Authors+Show Affiliations

General Internal Medicine Unit, Massachusetts General Hospital, Boston 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8905498

Citation

Meigs, J B., et al. "Interpreting Results of Prostate-specific Antigen Testing for Early Detection of Prostate Cancer." Journal of General Internal Medicine, vol. 11, no. 9, 1996, pp. 505-12.
Meigs JB, Barry MJ, Oesterling JE, et al. Interpreting results of prostate-specific antigen testing for early detection of prostate cancer. J Gen Intern Med. 1996;11(9):505-12.
Meigs, J. B., Barry, M. J., Oesterling, J. E., & Jacobsen, S. J. (1996). Interpreting results of prostate-specific antigen testing for early detection of prostate cancer. Journal of General Internal Medicine, 11(9), pp. 505-12.
Meigs JB, et al. Interpreting Results of Prostate-specific Antigen Testing for Early Detection of Prostate Cancer. J Gen Intern Med. 1996;11(9):505-12. PubMed PMID: 8905498.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interpreting results of prostate-specific antigen testing for early detection of prostate cancer. AU - Meigs,J B, AU - Barry,M J, AU - Oesterling,J E, AU - Jacobsen,S J, PY - 1996/9/1/pubmed PY - 1996/9/1/medline PY - 1996/9/1/entrez SP - 505 EP - 12 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 11 IS - 9 N2 - OBJECTIVE: Calculation of likelihood ratios for serum prostate-specific antigen (PSA) levels to discriminate potentially curable prostate cancer in men selected for having benign prostatic hyperplasia (BPH) or in randomly selected men. DESIGN: Retrospective analysis of prospectively measured PSA levels. SETTING: A tertiary referral center, a multicenter randomized controlled trial, and a community-based study, all providing PSA data. PATIENTS: We used PSA measurements from four groups of men aged 50 to 79 years: 276 men with organ-confined prostate cancer treated with radical prostatectomy, 305 randomly selected men without clinical evidence of prostate cancer or a history of surgery for BPH recruited for a community study, 173 men without cancer but with BPH coming to prostatectomy, and 770 men without cancer and with symptoms of BPH enrolled in the North American finasteride clinical trial. MEASUREMENTS AND MAIN RESULTS: Age-standardized, stratum-specific likelihood ratios for organ-confined prostate cancer were calculated separately for unselected men in the community sample and for selected men with BPH (pooling both BPH populations). Likelihood ratios ranged from 0.2 for PSA between 0.0 and 2.0 ng/mL to 54.8 for a PSA level of 10.1 ng/mL or higher in unselected men, but rose to only 2.9 for PSA values of 10.1 ng/mL or higher in men with BPH. Forty percent of the men in the community study had moderate to severe lower urinary tract symptoms. In these men, likelihood ratios ranged from 0.2 for PSA values between 0.0 and 2.0 ng/mL to 17.2 for PSA values of 6.1 ng/mL or higher, while in men with no or mild symptoms, likelihood ratios rose to 26.9 for PSA values of 6.1 ng/mL or higher. CONCLUSIONS: Likelihood ratios for PSA test results allow stratification of men along a continuum of risk for prostate cancer. Likelihood ratios demonstrate that the ability of the PSA test to discriminate potentially curable prostate cancer from BPH is dramatically lower in men selected with lower urinary tract symptoms than in randomly selected men. SN - 0884-8734 UR - https://www.unboundmedicine.com/medline/citation/8905498/Interpreting_results_of_prostate_specific_antigen_testing_for_early_detection_of_prostate_cancer_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=8905498.ui DB - PRIME DP - Unbound Medicine ER -