A panel of kallikrein markers can reduce unnecessary biopsy for prostate cancer: Data from the European Randomized Study of Prostate Cancer Screening in Göteborg, Sweden Journal Article


Authors: Vickers, A. J.; Cronin, A. M.; Aus, G.; Pihl, C. G.; Becker, C.; Pettersson, K.; Scardino, P. T.; Hugosson, J.; Lilja, H.
Article Title: A panel of kallikrein markers can reduce unnecessary biopsy for prostate cancer: Data from the European Randomized Study of Prostate Cancer Screening in Göteborg, Sweden
Abstract: Background: Prostate-specific antigen (PSA) is widely used to detect prostate cancer. The low positive predictive value of elevated PSA results in large numbers of unnecessary prostate biopsies. We set out to determine whether a multivariable model including four kallikrein forms (total, free, and intact PSA, and human kallikrein 2 (hK2)) could predict prostate biopsy outcome in previously unscreened men with elevated total PSA. Methods: The study cohort comprised 740 men in Göteborg, Sweden, undergoing biopsy during the first round of the European Randomized study of Screening for Prostate Cancer. We calculated the area-under-the-curve (AUC) for predicting prostate cancer at biopsy. AUCs for a model including age and PSA (the 'laboratory' model) and age, PSA and digital rectal exam (the 'clinical' model) were compared with those for models that also included additional kallikreins. Results: Addition of free and intact PSA and hK2 improved AUC from 0.68 to 0.83 and from 0.72 to 0.84, for the laboratory and clinical models respectively. Using a 20% risk of prostate cancer as the threshold for biopsy would have reduced the number of biopsies by 424 (57%) and missed only 31 out of 152 low-grade and 3 out of 40 high-grade cancers. Conclusion: Multiple kallikrein forms measured in blood can predict the result of biopsy in previously unscreened men with elevated PSA. A multivariable model can determine which men should be advised to undergo biopsy and which might be advised to continue screening, but defer biopsy until there was stronger evidence of malignancy. © 2008 Vickers et al; licensee BioMed Central Ltd.
Keywords: controlled study; major clinical study; clinical trial; area under the curve; cancer risk; comparative study; methodology; cancer grading; diagnostic accuracy; sensitivity and specificity; prostate specific antigen; controlled clinical trial; randomized controlled trial; cohort analysis; cancer screening; mass screening; prediction; biopsy; age; prostate cancer; europe; gleason score; sweden; prostate-specific antigen; prostatic neoplasms; blood; diagnostic value; models, statistical; prostate tumor; prostate biopsy; kallikrein; multivariate analysis; statistical model; patient counseling; digital rectal examination; unnecessary procedure; vein puncture
Journal Title: BMC Medicine
Volume: 6
ISSN: 1741-7015
Publisher: Biomed Central Ltd  
Date Published: 2008-07-08
Start Page: 19
Language: English
DOI: 10.1186/1741-7015-6-19
PUBMED: 18611265
PROVIDER: scopus
PMCID: PMC2474851
DOI/URL:
Notes: --- - "Cited By (since 1996): 29" - "Export Date: 17 November 2011" - "Source: Scopus"
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MSK Authors
  1. Peter T Scardino
    622 Scardino
  2. Hans Gosta Lilja
    286 Lilja
  3. Andrew J Vickers
    570 Vickers
  4. Angel M Cronin
    145 Cronin