Predictive properties of serum prostate-specific antigen testing in a community-based setting

Steven J. Jacobsen, Erik J. Bergstralh, Harry A. Guess, Slavica K Katusic, George G. Klee, Joseph E. Oesterling, Michael M. Lieber

Research output: Contribution to journalArticle

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Abstract

Background: Most studies that have described the sensitivity and specificity of prostate-specific antigen (PSA) as a screening test have been conducted in urology practice settings or in media-based screening programs. The control patients from these settings may have a higher prevalence of urologic disorders that increase serum PSA levels than that of the general population in which screening efforts might take place, leading to biased estimates of sensitivity and specificity. Objective: To determine the sensitivity and specificity of serum PSA levels for the early detection of prostate cancer in a population-based setting. Patients and Methods: This population-based case-control study was conducted in Olmsted County, Minnesota, where the Rochester Epidemiology Project could identify all incident cases of prostate cancer through passive surveillance of medical care provided to local residents. Case patients were all 177 men (age range, 50-79 years) who were newly diagnosed as having prostate cancer from 1990 through 1992 and had a prediagnostic serum PSA determination (90% of all incident cases). Control patients were randomly selected from the Olmsted County population and had undergone a clinical examination to exclude prostate cancer. Results: The median (25th and 75th percentiles) of serum PSA levels was 9.4 ng/mL (5.4 and 18.6 ng/mL, respectively) for case patients and 1.2 ng/mL (0.7 and 2.1 ng/mL, respectively) for control patients (P<.001). When sensitivity was plotted against 1-specificity, the area under the receiver operating characteristic curve was 0.94 (SE, 0.01). The predictive power declined somewhat with age, with areas under the curve of 0.96, 0.94, and 0.90 fur men in their 50s, 60s, and 70s, respectively. When cases were restricted to the 155 men with clinically localized disease, the area under the curve was essentially unchanged (0.94; SE, 0.01) and still much greater than the estimates of 0.75 that were reported from urology practice and media-based settings. Conclusions: In a community-based setting, serum PSA levels provide better discrimination between men with and without clinically localized prostate cancer than has been observed in studies that were conducted in urologic practices. These results suggest that previous decision analyses may have underestimated the predictive value of PSA for the detection of prostate cancer in a primary care or community-wide screening program.

Original languageEnglish (US)
Pages (from-to)2462-2468
Number of pages7
JournalArchives of Internal Medicine
Volume156
Issue number21
DOIs
StatePublished - Nov 25 1996

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Prostate-Specific Antigen
Prostatic Neoplasms
Serum
Urology
Sensitivity and Specificity
Population
Area Under Curve
Decision Support Techniques
Early Detection of Cancer
ROC Curve
Case-Control Studies
Primary Health Care
Epidemiology

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Jacobsen, S. J., Bergstralh, E. J., Guess, H. A., Katusic, S. K., Klee, G. G., Oesterling, J. E., & Lieber, M. M. (1996). Predictive properties of serum prostate-specific antigen testing in a community-based setting. Archives of Internal Medicine, 156(21), 2462-2468. https://doi.org/10.1001/archinte.156.21.2462

Predictive properties of serum prostate-specific antigen testing in a community-based setting. / Jacobsen, Steven J.; Bergstralh, Erik J.; Guess, Harry A.; Katusic, Slavica K; Klee, George G.; Oesterling, Joseph E.; Lieber, Michael M.

In: Archives of Internal Medicine, Vol. 156, No. 21, 25.11.1996, p. 2462-2468.

Research output: Contribution to journalArticle

Jacobsen, SJ, Bergstralh, EJ, Guess, HA, Katusic, SK, Klee, GG, Oesterling, JE & Lieber, MM 1996, 'Predictive properties of serum prostate-specific antigen testing in a community-based setting', Archives of Internal Medicine, vol. 156, no. 21, pp. 2462-2468. https://doi.org/10.1001/archinte.156.21.2462
Jacobsen, Steven J. ; Bergstralh, Erik J. ; Guess, Harry A. ; Katusic, Slavica K ; Klee, George G. ; Oesterling, Joseph E. ; Lieber, Michael M. / Predictive properties of serum prostate-specific antigen testing in a community-based setting. In: Archives of Internal Medicine. 1996 ; Vol. 156, No. 21. pp. 2462-2468.
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abstract = "Background: Most studies that have described the sensitivity and specificity of prostate-specific antigen (PSA) as a screening test have been conducted in urology practice settings or in media-based screening programs. The control patients from these settings may have a higher prevalence of urologic disorders that increase serum PSA levels than that of the general population in which screening efforts might take place, leading to biased estimates of sensitivity and specificity. Objective: To determine the sensitivity and specificity of serum PSA levels for the early detection of prostate cancer in a population-based setting. Patients and Methods: This population-based case-control study was conducted in Olmsted County, Minnesota, where the Rochester Epidemiology Project could identify all incident cases of prostate cancer through passive surveillance of medical care provided to local residents. Case patients were all 177 men (age range, 50-79 years) who were newly diagnosed as having prostate cancer from 1990 through 1992 and had a prediagnostic serum PSA determination (90{\%} of all incident cases). Control patients were randomly selected from the Olmsted County population and had undergone a clinical examination to exclude prostate cancer. Results: The median (25th and 75th percentiles) of serum PSA levels was 9.4 ng/mL (5.4 and 18.6 ng/mL, respectively) for case patients and 1.2 ng/mL (0.7 and 2.1 ng/mL, respectively) for control patients (P<.001). When sensitivity was plotted against 1-specificity, the area under the receiver operating characteristic curve was 0.94 (SE, 0.01). The predictive power declined somewhat with age, with areas under the curve of 0.96, 0.94, and 0.90 fur men in their 50s, 60s, and 70s, respectively. When cases were restricted to the 155 men with clinically localized disease, the area under the curve was essentially unchanged (0.94; SE, 0.01) and still much greater than the estimates of 0.75 that were reported from urology practice and media-based settings. Conclusions: In a community-based setting, serum PSA levels provide better discrimination between men with and without clinically localized prostate cancer than has been observed in studies that were conducted in urologic practices. These results suggest that previous decision analyses may have underestimated the predictive value of PSA for the detection of prostate cancer in a primary care or community-wide screening program.",
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AU - Oesterling, Joseph E.

AU - Lieber, Michael M.

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N2 - Background: Most studies that have described the sensitivity and specificity of prostate-specific antigen (PSA) as a screening test have been conducted in urology practice settings or in media-based screening programs. The control patients from these settings may have a higher prevalence of urologic disorders that increase serum PSA levels than that of the general population in which screening efforts might take place, leading to biased estimates of sensitivity and specificity. Objective: To determine the sensitivity and specificity of serum PSA levels for the early detection of prostate cancer in a population-based setting. Patients and Methods: This population-based case-control study was conducted in Olmsted County, Minnesota, where the Rochester Epidemiology Project could identify all incident cases of prostate cancer through passive surveillance of medical care provided to local residents. Case patients were all 177 men (age range, 50-79 years) who were newly diagnosed as having prostate cancer from 1990 through 1992 and had a prediagnostic serum PSA determination (90% of all incident cases). Control patients were randomly selected from the Olmsted County population and had undergone a clinical examination to exclude prostate cancer. Results: The median (25th and 75th percentiles) of serum PSA levels was 9.4 ng/mL (5.4 and 18.6 ng/mL, respectively) for case patients and 1.2 ng/mL (0.7 and 2.1 ng/mL, respectively) for control patients (P<.001). When sensitivity was plotted against 1-specificity, the area under the receiver operating characteristic curve was 0.94 (SE, 0.01). The predictive power declined somewhat with age, with areas under the curve of 0.96, 0.94, and 0.90 fur men in their 50s, 60s, and 70s, respectively. When cases were restricted to the 155 men with clinically localized disease, the area under the curve was essentially unchanged (0.94; SE, 0.01) and still much greater than the estimates of 0.75 that were reported from urology practice and media-based settings. Conclusions: In a community-based setting, serum PSA levels provide better discrimination between men with and without clinically localized prostate cancer than has been observed in studies that were conducted in urologic practices. These results suggest that previous decision analyses may have underestimated the predictive value of PSA for the detection of prostate cancer in a primary care or community-wide screening program.

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