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New Insights Into the Diagnostic Accuracy of Complexed and Total Prostate Specific Antigen Using Discordance Analysis Characteristics

2006; Lippincott Williams & Wilkins; Volume: 175; Issue: 4 Linguagem: Inglês

10.1016/s0022-5347(05)00707-x

1527-3792

Klaus Jung, Michael Lein, Hermann Butz, Carsten Stephan, Stefan A. Loening, Thomas Keller,

Hepatitis B Virus Studies

No AccessJournal of UrologyAdult urology1 Apr 2006New Insights Into the Diagnostic Accuracy of Complexed and Total Prostate Specific Antigen Using Discordance Analysis Characteristicsis accompanied byProstate Specific Antigen and Other Markers for Prostate Cancer Klaus Jung, Michael Lein, Hermann Butz, Carsten Stephan, Stefan A. Loening, and Thomas Keller Klaus JungKlaus Jung More articles by this author , Michael LeinMichael Lein More articles by this author , Hermann ButzHermann Butz Financial interest and/or other relationship with Bayer Diagnostics. More articles by this author , Carsten StephanCarsten Stephan More articles by this author , Stefan A. LoeningStefan A. Loening More articles by this author , and Thomas KellerThomas Keller Financial interest and/or other relationship with Bayer-Vital GmbH. Recipient of grant from Bayer Vital GmbH, Fernwald, Germany to develop the DAC program. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00707-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Comparison of diagnostic performances of total and complexed prostate specific antigen (tPSA, cPSA) using ROC curve analysis resulted in controversial interpretations. To overcome the biases due to analysis of subgroups selected by concentration ranges of only 1 marker the novel approach named discordance analysis characteristics is presented. Materials and Methods: DAC method includes only patients who are discordantly categorized by the tests under investigation using cutoffs with identical sensitivity. Within those patients parameters describing diagnostic accuracy are calculated. The systematic nature of the results is confirmed by varying the cutoffs. DAC method is demonstrated considering the example of cPSA and tPSA data from 2 prostate cancer studies with a total of 1,624 patients (study A and B, of 283 and 565 with as well as 417 and 359 men without prostate cancer, respectively). PSA concentrations were measured using the Bayer assays. Results: The DAC method proved that cPSA outperformed tPSA regarding the criteria diagnostic specificity and positive predictive value. Among discordantly tested patients cPSA detected patients with an about 2-fold higher risk to have prostate cancer and with a 3.6 to 5.5-fold better specificity than tPSA. Using cPSA instead of tPSA more than 10% of unnecessary biopsies could be avoided in the tPSA range of 3 to 5 ng/ml. Conclusions: The superior diagnostic performance of cPSA in comparison with tPSA warrants the recommendation to use cPSA as initial test in prostate cancer diagnostics. 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Google Scholar 19 : Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med2004; 350: 2239. Google Scholar Department of Urology, University Hospital Charité, Berlin, Bayer Vital GmbH, Leverkusen, and ACOMED Statistics, Leipzig, Germany© 2006 by American Urological AssociationFiguresReferencesRelatedDetailsRelated articlesJournal of Urology9 Nov 2018Prostate Specific Antigen and Other Markers for Prostate Cancer Volume 175Issue 4April 2006Page: 1275-1280 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsdiagnosisprostatic neoplasmsprostate-specific antigenROC curveAcknowledgmentsSabine Becker, Silke Klotzek and Janett Reiche provided technical support.MetricsAuthor Information Klaus Jung More articles by this author Michael Lein More articles by this author Hermann Butz Financial interest and/or other relationship with Bayer Diagnostics. More articles by this author Carsten Stephan More articles by this author Stefan A. Loening More articles by this author Thomas Keller Financial interest and/or other relationship with Bayer-Vital GmbH. Recipient of grant from Bayer Vital GmbH, Fernwald, Germany to develop the DAC program. More articles by this author Expand All Advertisement PDF downloadLoading ...