The relationship between prostate-specific antigen and prostate cancer risk: the Prostate Biopsy Collaborative Group.

Journal article

PURPOSE: The relationship between prostate-specific antigen (PSA) level and prostate cancer risk remains subject to fundamental disagreements. We hypothesized that the risk of prostate cancer on biopsy for a given PSA level is affected by identifiable characteristics of the cohort under study. EXPERIMENTAL DESIGN: We used data from five European and three U.S. cohorts of men undergoing biopsy for prostate cancer; six were population-based studies and two were clinical cohorts. The association between PSA and prostate cancer was calculated separately for each cohort using locally weighted scatterplot smoothing. RESULTS: The final data set included 25,772 biopsies and 8,503 cancers. There were gross disparities between cohorts with respect to both the prostate cancer risk at a given PSA level and the shape of the risk curve. These disparities were associated with identifiable differences between cohorts: for a given PSA level, a greater number of biopsy cores increased the risk of cancer (odds ratio for >6- versus 6-core biopsy, 1.35; 95% confidence interval, 1.18-1.54; P < 0.0005); recent screening led to a smaller increase in risk per unit change in PSA (P = 0.001 for interaction term) and U.S. cohorts had higher risk than the European cohorts (2.14; 95% confidence interval, 1.99-2.30; P < 0.0005). CONCLUSIONS: Our results suggest that the relationship between PSA and risk of a positive prostate biopsy varies, both in terms of the probability of prostate cancer at a given PSA value and the shape of the risk curve. This poses challenges to the use of PSA-driven algorithms to determine whether biopsy is indicated.

Authors: Vickers, A; Cronin, A; Roobol, M; Hugosson, J; Jones, J

• Publication status: Published
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research
• Volume: 16
• Issue: 17
• Pages: 4374-4381
• Publication date: 2010-09-01
• DOI: 10.1158/1078-0432.ccr-10-1328
• EISSN: 1557-3265
• ISSN: 1078-0432
• Language: English
• Keywords: Europe; Middle Aged; Prostate-Specific Antigen; Prostate; Aged; Prostatic Neoplasms; Humans; Risk Factors; Male; Biopsy; United States; Risk Assessment; Odds Ratio