The relationship between prostate-specific antigen and prostate cancer risk: The Prostate Biopsy Collaborative Group Journal Article


Authors: Vickers, A. J.; Cronin, A. M.; Roobol, M. J.; Hugosson, J.; Jones, J. S.; Kattan, M. W.; Klein, E.; Hamdy, F.; Neal, D.; Donovan, J.; Parekh, D. J.; Ankerst, D.; Bartsch, G.; Klocker, H.; Horninger, W.; Benchikh, A.; Salama, G.; Villers, A.; Freedland, S. J.; Moreira, D. M.; Schroder, F. H.; Lilja, H.
Article Title: The relationship between prostate-specific antigen and prostate cancer risk: The Prostate Biopsy Collaborative Group
Abstract: 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. ©2010 AACR.
Keywords: adult; aged; middle aged; major clinical study; cancer risk; united states; prostate specific antigen; cohort analysis; odds ratio; risk factors; biopsy; risk assessment; prostate cancer; europe; prostate-specific antigen; prostatic neoplasms; prostate; probability; prostate biopsy
Journal Title: Clinical Cancer Research
Volume: 16
Issue: 17
ISSN: 1078-0432
Publisher: American Association for Cancer Research  
Date Published: 2010-09-01
Start Page: 4374
End Page: 4381
Language: English
DOI: 10.1158/1078-0432.ccr-10-1328
PUBMED: 20736330
PROVIDER: scopus
PMCID: PMC2937360
DOI/URL:
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 20 April 2011" - "CODEN: CCREF" - "Source: Scopus"
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MSK Authors
  1. Hans Gosta Lilja
    286 Lilja
  2. Andrew J Vickers
    556 Vickers
  3. Angel M Cronin
    145 Cronin