Selection of optimal prostate specific antigen cutoffs for early detection of prostate cancer: Receiver operating characteristic curves

W. J. Catalona, M. A. Hudson, P. T. Scardino, J. P. Richie, F. R. Ahmann, R. C. Flanigan, J. B. DeKernion, T. L. Ratliff, L. R. Kavoussi, B. L. Dalkin, W. B. Waters, M. T. MacFarlane, P. C. Southwick

Research output: Contribution to journalArticle

232 Scopus citations

Abstract

A prospective clinical trial of prostate cancer screening was conducted at 6 university centers including 6,630 men 50 years old or older who underwent a serum prostate specific antigen (PSA) determination and digital rectal examination. Biopsies were performed if the PSA level was greater than 4.0 ng./ml. (Hybritech Tandem assay) or digital rectal examination was suspicious for cancer. We evaluated the effect on biopsy rate and cancer detection if the cutoff value was shifted from 4.0 to age-specific reference ranges recommended in the literature. In men 50 to 59 years old with normal digital rectal examination findings a decrease from 4.0 to 3.5 ng./ml. would have resulted in a 45% increase in the number of biopsies (39 of 87) and a projected 15% increase in cancer detection. An increase from 4.0 to 4.5 ng./ml. in men 60 to 69 years old would result in 15% fewer biopsies (35 of 238) and would miss 8% of the organ confined tumors (2 of 25). Increasing the cutoff to 6.5 ng./ml. in men 70 years old or older would result in 44% fewer biopsies (70 of 159) and would miss 47% of the organ confined cancers (7 of 15). The number of biopsies performed for each cancer detected with a PSA level of greater than 4.0 ng./ml. remains constant across age groupings, which suggests that the cutoff of 4.0 ng./ml. does not need to be altered in the older men, since it is apparently unaffected by the simultaneously increasing prevalence of benign prostatic hyperplasia and cancer with age. We conclude that a serum PSA concentration of 4.0 ng./ml. should be used as a general guideline for biopsy in all age groups.

Original languageEnglish (US)
Pages (from-to)2037-2042
Number of pages6
JournalJournal of Urology
Volume152
Issue number6 I
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

    Fingerprint

Keywords

  • ROC curves
  • antigens, neoplasm
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Catalona, W. J., Hudson, M. A., Scardino, P. T., Richie, J. P., Ahmann, F. R., Flanigan, R. C., DeKernion, J. B., Ratliff, T. L., Kavoussi, L. R., Dalkin, B. L., Waters, W. B., MacFarlane, M. T., & Southwick, P. C. (1994). Selection of optimal prostate specific antigen cutoffs for early detection of prostate cancer: Receiver operating characteristic curves. Journal of Urology, 152(6 I), 2037-2042. https://doi.org/10.1016/S0022-5347(17)32300-5