Should Modest elevations in prostate-specific antigen, international prostate symptom score, or their rates of increase over time be used as surrogate measures of incident benign prostatic hyperplasia?

Jeannette M. Schenk, Rachel Hunter-Merrill, Yingye Zheng, Ruth Etzioni, Roman Gulati, Catherine Tangen, Ian M. Thompson, Alan R. Kristal

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Although surrogate measures of benign prostatic hyperplasia (BPH) are often used in epidemiologic studies, their performance characteristics are unknown. Using data from the Prostate Cancer Prevention Trial (n = 5,986), we evaluated prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), and their rates of change as predictors of incident BPH. BPH (n = 842 cases) was defined as medical or surgical treatment or at least 2 IPSS of 15 or higher. Proportional hazards models were used to measure the associations of baseline PSA, IPSS, and their velocities over 2 years with BPH risk, and time-dependent receiver-operating characteristic curves were used to measure their discriminatory performance. Unit increases in PSA, IPSS, and IPSS velocity were associated with 34%, 35%, and 29% (all P < 0.001) increases in BPH risk, respectively. The areas under the receiver-operating characteristic curves were significantly greater than 0.5 for PSA (0.58, 95% confidence interval (CI): 0.56, 0.60), IPSS (0.77, 95% CI: 0.75, 0.78), and IPSS velocity (0.63, 95% CI: 0.61, 0.65); however there were no cut points at which sensitivity and specificity were both above 75%. We concluded that moderate elevations in PSA, IPSS, or their rates of change should not be used as surrogate measures of incident BPH.

Original languageEnglish (US)
Pages (from-to)741-751
Number of pages11
JournalAmerican journal of epidemiology
Issue number5
StatePublished - Sep 1 2013



  • International Prostate Symptom Score
  • benign prostatic hyperplasia
  • prostate-specific antigen

ASJC Scopus subject areas

  • Epidemiology

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