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Updated: Jun 20, 2026
Microarray-based Identification of Individual HERV Loci Expression: Application to Biomarker Discovery in Prostate Cancer
Published on: November 2, 2013
Prostate specific antigen for early detection of prostate cancer: longitudinal study
Benny Holmström1, Mattias Johansson, Anders Bergh
1Department of Surgery, Gävle Hospital, S-801 87 Gävle, Sweden.
Objective:
To evaluate if prostate specific antigen test attains validity standards required for screening in view of recent prostate cancer screening trial results.
Design:
Case-control study nested in longitudinal cohort.
Setting:
Västerbotten Intervention Project cohort, Umeå, Sweden.
Participants:
540 cases and 1034 controls matched for age and date of blood draw.
Main Outcome Measure:
Validity of prostate specific antigen for prediction of subsequent prostate cancer diagnosis by record linkage to cancer registry.
Results:
Blood samples were drawn on average 7.1 (SD 3.7) years before diagnosis. The area under the curve for prostate specific antigen was 0.84 (95% confidence interval 0.82 to 0.86). At prostate specific antigen cut-off values of 3, 4, and 5 ng/ml, sensitivity estimates were 59%, 44%, and 33%, and specificity estimates were 87%, 92%, and 95%. The positive likelihood ratio commonly considered to "rule in disease" is 10; in this study the positive likelihood ratios were 4.5, 5.5, and 6.4 for prostate specific antigen cut-off values of 3, 4, and 5 ng/ml. The negative likelihood ratio commonly considered to "rule out disease" is 0.1; in this study the negative likelihood ratios were 0.47, 0.61, and 0.70 for prostate specific antigen cut-off values of 3, 4, and 5 ng/ml. For a cut-off of 1.0 ng/ml, the negative likelihood ratio was 0.08.
Conclusions:
No single cut-off value for prostate specific antigen concentration attained likelihood ratios formally required for a screening test. Prostate specific antigen concentrations below 1.0 ng/ml virtually ruled out a prostate cancer diagnosis during the follow-up. Additional biomarkers for early detection of prostate cancer are needed before population based screening for prostate cancer should be introduced.
