Evaluating Prostate Cancer Screening Antigen Threshold

According to co-lead authors, Yan Jin and Jae Hung Jung, the diagnostic accuracy of prostate-specific antigen (PSA) values below 4 ng/mL for prostate cancer screening in a hospital setting is “inconclusive.” They conducted a systematic literature review on PSA cutoffs below 4 ng/mL during hospitalizations and found that, “although a PSA cutoff <3 ng/mL is relatively more sensitive and specific than PSA ≥3 ng/mL, no significant differences in sensitivity and specificity were found in the diagnosis of prostate cancer.”

The investigators reviewed a total of 11 studies on prostate cancer screening for their meta-analysis. According to the article in Investigative and Clinical Urology, a PSA cutoff below 4 ng/mL demonstrated a sensitivity of 0.92 and a specificity of 0.16. Additionally, authors calculated that “the area under the hierarchical summary receiver operating characteristic curve was 0.87, the positive likelihood ratio was 1.23, the negative likelihood ratio was 0.46, and the diagnostic odds ratio was 2.64.”

Prostate Cancer Screening Threshold Analysis

Researchers also observed that diagnostic sensitivity and specificity varied by PSA cutoff ranges, with 2.00–2.99 ng/mL having 0.94 and 3.00–3.99 ng/mL having 0.17 and 0.92 sensitivity and specificity, respectively. Reportedly, “no significant differences in the sensitivity and specificity of PSA cutoffs in the range of 2 to 2.99 ng/mL and 3 to 3.99 ng/mL were found” in prostate cancer screening during hospitalization.

The full article acknowledges that the study was limited by a “huge” clinical heterogeneity among their included studies due to “the baseline differences in PSA levels and DRE findings among the study population.” Additionally, “some studies did not aim to evaluate the test performance of PSA but focused on diagnostic tools,” and nearly all were the studies “were rated as having a high ROB in the index test domain, as the PSA cutoff threshold was not prespecified.”

In closing, the study’s authors proposed that “clinicians should choose an appropriate PSA cutoff on the basis of clinical circumstances and patients’ characteristics” for the purposes of prostate cancer screening.

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