Prostate-specific antigen testing accuracy in community practice

被引：54
作者：
Hoffman R.M. [1 ,2 ]
Gilliland F.D. [3 ]
Adams-Cameron M. [2 ]
Hunt W.C. [2 ]
Key C.R. [2 ]
机构：
[1] Department of Medicine, New Mexico VA Health Care System, Albuquerque, NM
[2] New Mexico Tumor Registry, Univ. of New Mexico Hlth. Sci. Ctr., Albuquerque, NM
[3] Department of Preventive Medicine, University of Southern California, Los Angeles, CA
来源：
BMC Family Practice | / 3卷 / 1期
关键词：
Likelihood functions; Prostate-specific antigen; Prostatic neoplasms; ROC curve; Sensitivity and specificity;
D O I：
10.1186/1471-2296-3-19
中图分类号：
学科分类号：
摘要：
Background: Most data on prostate-specific antigen (PSA) testing come from urologic cohorts comprised of volunteers for screening programs. We evaluated the diagnostic accuracy of PSA testing for detecting prostate cancer in community practice. Methods: PSA testing results were compared with a reference standard of prostate biopsy. Subjects were 2,620 men 40 years and older undergoing (PSA) testing and biopsy from 1/1/95 through 12/31/98 in the Albuquerque, New Mexico metropolitan area. Diagnostic measures included the area under the receiver-operating characteristic curve, sensitivity, specificity, and likelihood ratios. Results: Cancer was detected in 930 subjects (35%). The area under the ROC curve was 0.67 and the PSA cutpoint of 4 ng/ml had a sensitivity of 86% and a specificity of 33%. The likelihood ratio for a positive test (LR+) was 1.28 and 0.42 for a negative test (LR-). PSA testing was most sensitive (90%) but least specific (27%) in older men. Age-specific reference ranges improved specificity in older men (49%) but decreased sensitivity (70%), with an LR+ of 1.38. Lowering the PSA cutpoint to 2 ng/ml resulted in a sensitivity of 95%, a specificity of 20%, and an LR+ of 1.19. Conclusions: PSA testing had fair discriminating power for detecting prostate cancer in community practice. The PSA cutpoint of 4 ng/ml was sensitive but relatively non-specific and associated likelihood ratios only moderately revised probabilities for cancer. Using age-specific reference ranges and a PSA cutpoint below 4 ng/ml improved test specificity and sensitivity, respectively, but did not improve the overall accuracy of PSA testing.
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页码：1 / 8
页数：7
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