Critical Appraisal of Prostate-specific Antigen in Prostate Cancer Screening: 20 Years Later

Timeline of prostate-specific antigen (PSA) discovery and development.

Risk of prostate cancer (PCa) as function of prostate-specific antigen (PSA) level, digital rectal examination (DRE) result, and family history of PCa for men who had not previously undergone prostate biopsy. Vertical lines indicate pointwise 95% confidence intervals for risk at each PSA level. DRE+, abnormal DRE findings suggestive of PCa; DRE–, normal DRE findings; FAM HIST+, family history of PCa; FAM HIST–, no family history of PCa. Reprinted, with permission, from Thompson et al.²¹

Receiver operating characteristic curves for prostate-specific antigen (PSA), Prostate Cancer Prevention Trial (PCPT) risk calculator, and novel logistic-regression based model for predicting prostate cancer (PCa). Reprinted, with permission, from Hernandez et al.²⁵

Number and percentages of prostate cancer cases detected by prostate-specific antigen (PSA) level. Data from Thompson et al.⁴³

Receiver operating characteristic (ROC) curves for prostate-specific antigen (PSA) detection of all prostate cancer (PCa) and high-grade PCa. (Left) ROC curves for all prostate cancer; (Middle) ROC curves for Gleason score ≥ 7 PCa; (Right) ROC curves for Gleason score ≥8 PCa. Solid line indicates placebo group; dashed line indicates finasteride group. For difference between placebo and finasteride groups, P < .001 for all PCa, P = .003 for Gleason score ≥7 PCa, and P = .071 for Gleason score ≥8 PCa. Reprinted, with permission, from Thompson et al.⁴⁶