A panel of kallikrein markers can predict outcome of prostate biopsy following clinical work-up: An independent validation study from the European Randomized Study of Prostate Cancer screening, France Journal Article


Authors: Benchikh, A.; Savage, C.; Cronin, A.; Salama, G.; Villers, A.; Lilja, H.; Vickers, A.
Article Title: A panel of kallikrein markers can predict outcome of prostate biopsy following clinical work-up: An independent validation study from the European Randomized Study of Prostate Cancer screening, France
Abstract: Background: We have previously shown that a panel of kallikrein markers - total prostate-specific antigen (PSA), free PSA, intact PSA and human kallikrein-related peptidase 2 (hK2) - can predict the outcome of prostate biopsy in men with elevated PSA. Here we investigate the properties of our panel in men subject to clinical work-up before biopsy.Methods: We applied a previously published predictive model based on the kallikrein panel to 262 men undergoing prostate biopsy following an elevated PSA (≥ 3 ng/ml) and further clinical work-up during the European Randomized Study of Prostate Cancer screening, France. The predictive accuracy of the model was compared to a "base" model of PSA, age and digital rectal exam (DRE).Results: 83 (32%) men had prostate cancer on biopsy of whom 45 (54%) had high grade disease (Gleason score 7 or higher). Our model had significantly higher accuracy than the base model in predicting cancer (area-under-the-curve [AUC] improved from 0.63 to 0.78) or high-grade cancer (AUC increased from 0.77 to 0.87). Using a decision rule to biopsy those with a 20% or higher risk of cancer from the model would reduce the number of biopsies by nearly half. For every 1000 men with elevated PSA and clinical indication for biopsy, the model would recommend against biopsy in 61 men with cancer, the majority (≈80%) of whom would have low stage and low grade disease at diagnosis.Conclusions: In this independent validation study, the model was highly predictive of prostate cancer in men for whom the decision to biopsy is based on both elevated PSA and clinical work-up. Use of this model would reduce a large number of biopsies while missing few cancers. © 2010 Benchikh et al; licensee BioMed Central Ltd.
Keywords: adult; controlled study; human tissue; treatment outcome; aged; middle aged; clinical trial; area under the curve; cancer risk; cancer staging; outcome assessment; methodology; cancer grading; diagnostic accuracy; reproducibility; prostate specific antigen; reproducibility of results; metabolism; controlled clinical trial; randomized controlled trial; clinical assessment; cancer screening; validation study; prediction; biopsy; prostate cancer; europe; gleason score; prostate-specific antigen; prostatic neoplasms; biosynthesis; early diagnosis; models, statistical; prostate tumor; prostate biopsy; kallikrein; intermethod comparison; area under curve; high risk population; statistical model; early detection of cancer; kallikreins; marker gene; france; digital rectal examination
Journal Title: BMC Cancer
Volume: 10
ISSN: 1471-2407
Publisher: Biomed Central Ltd  
Date Published: 2010-11-22
Start Page: 635
Language: English
DOI: 10.1186/1471-2407-10-635
PUBMED: 21092177
PROVIDER: scopus
PMCID: PMC2996396
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "Art. No.: 635" - "CODEN: BCMAC" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Caroline Savage
    80 Savage
  2. Hans Gosta Lilja
    286 Lilja
  3. Andrew J Vickers
    569 Vickers
  4. Angel M Cronin
    145 Cronin