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Impact of Recent Screening on Predicting the Outcome of Prostate Cancer Biopsy in Men With Elevated Prostate-Specific Antigen Data From the European Randomized Study of Prostate Cancer Screening in Gothenburg, Sweden

Vickers, Andrew J.; Cronin, Angel M.; Aus, Gunnar; Pihl, Carl-Gustav; Becker, Charlotte LU ; Pettersson, Kim; Scardino, Peter T.; Hugosson, Jonas and Lilja, Hans LU (2010) In Cancer 116(11). p.2612-2620
Abstract
BACKGROUND: Risk models to predict prostate cancer on biopsy, whether they include only prostate-specific antigen (PSA) or other markers, are intended for use in all men of screening age. However, the association between PSA and cancer probably depends on a man's recent screening history. METHODS: The authors examined the effect of prior screening on the ability to predict the risk of prostate cancer by using a previously reported, 4-kallikrein panel that included total PSA, free PSA, intact PSA, and human kallikrein-related peptidase 2 (hK2). The study cohort comprised 1241 men in Gothenburg, Sweden who underwent biopsy for elevated PSA during their second or later visit for the European Randomized Study of Screening for Prostate Cancer.... (More)
BACKGROUND: Risk models to predict prostate cancer on biopsy, whether they include only prostate-specific antigen (PSA) or other markers, are intended for use in all men of screening age. However, the association between PSA and cancer probably depends on a man's recent screening history. METHODS: The authors examined the effect of prior screening on the ability to predict the risk of prostate cancer by using a previously reported, 4-kallikrein panel that included total PSA, free PSA, intact PSA, and human kallikrein-related peptidase 2 (hK2). The study cohort comprised 1241 men in Gothenburg, Sweden who underwent biopsy for elevated PSA during their second or later visit for the European Randomized Study of Screening for Prostate Cancer. The predictive accuracy of the 4-kallikrein panel was calculated. RESULTS: Total PSA was not predictive of prostate cancer. The previously published 4-kallikrein model increased predictive accuracy compared with total PSA and age alone (area under the curve [AUC], 0.66 vs 0.51; P < .001) but was poorly calibrated and missed many cancers. A model that was developed with recently screened men provided important improvements in discrimination (AUC, 0.67 vs 0.56; P < .001). Using this model reduced the number of biopsies by 413 per 1000 men with elevated PSA, missed 60 of 216 low-grade cancers (Gleason score <= 6), but missed only 1 of 43 high-grade cancers. CONCLUSIONS: Previous participation in PSA screening dramatically changed the performance of statistical models that were designed to predict biopsy outcome. A 4-kallikrein panel was able to predict prostate cancer in men who had a recent screening history and provided independent confirmation that multiple kallikrein forms contribute important diagnostic information for men with elevated PSA. Cancer 2010;116:2612-20. (C) 2010 American Cancer Society. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
prostate specific antigen, prostate cancer, screening, kallikreins, molecular markers
in
Cancer
volume
116
issue
11
pages
2612 - 2620
publisher
John Wiley & Sons
external identifiers
  • wos:000277989100015
  • scopus:77952800766
ISSN
1097-0142
DOI
10.1002/cncr.25010
language
English
LU publication?
yes
id
c6b12ff7-6ae7-49a6-9f99-1d9fa306961f (old id 1616835)
date added to LUP
2010-06-22 13:16:23
date last changed
2018-07-15 03:07:42
@article{c6b12ff7-6ae7-49a6-9f99-1d9fa306961f,
  abstract     = {BACKGROUND: Risk models to predict prostate cancer on biopsy, whether they include only prostate-specific antigen (PSA) or other markers, are intended for use in all men of screening age. However, the association between PSA and cancer probably depends on a man's recent screening history. METHODS: The authors examined the effect of prior screening on the ability to predict the risk of prostate cancer by using a previously reported, 4-kallikrein panel that included total PSA, free PSA, intact PSA, and human kallikrein-related peptidase 2 (hK2). The study cohort comprised 1241 men in Gothenburg, Sweden who underwent biopsy for elevated PSA during their second or later visit for the European Randomized Study of Screening for Prostate Cancer. The predictive accuracy of the 4-kallikrein panel was calculated. RESULTS: Total PSA was not predictive of prostate cancer. The previously published 4-kallikrein model increased predictive accuracy compared with total PSA and age alone (area under the curve [AUC], 0.66 vs 0.51; P &lt; .001) but was poorly calibrated and missed many cancers. A model that was developed with recently screened men provided important improvements in discrimination (AUC, 0.67 vs 0.56; P &lt; .001). Using this model reduced the number of biopsies by 413 per 1000 men with elevated PSA, missed 60 of 216 low-grade cancers (Gleason score &lt;= 6), but missed only 1 of 43 high-grade cancers. CONCLUSIONS: Previous participation in PSA screening dramatically changed the performance of statistical models that were designed to predict biopsy outcome. A 4-kallikrein panel was able to predict prostate cancer in men who had a recent screening history and provided independent confirmation that multiple kallikrein forms contribute important diagnostic information for men with elevated PSA. Cancer 2010;116:2612-20. (C) 2010 American Cancer Society.},
  author       = {Vickers, Andrew J. and Cronin, Angel M. and Aus, Gunnar and Pihl, Carl-Gustav and Becker, Charlotte and Pettersson, Kim and Scardino, Peter T. and Hugosson, Jonas and Lilja, Hans},
  issn         = {1097-0142},
  keyword      = {prostate specific antigen,prostate cancer,screening,kallikreins,molecular markers},
  language     = {eng},
  number       = {11},
  pages        = {2612--2620},
  publisher    = {John Wiley & Sons},
  series       = {Cancer},
  title        = {Impact of Recent Screening on Predicting the Outcome of Prostate Cancer Biopsy in Men With Elevated Prostate-Specific Antigen Data From the European Randomized Study of Prostate Cancer Screening in Gothenburg, Sweden},
  url          = {http://dx.doi.org/10.1002/cncr.25010},
  volume       = {116},
  year         = {2010},
}