The relationship between prostate-specific antigen and prostate cancer risk: The prostate biopsy collaborative group

Andrew J. Vickers, Angel M. Cronin, Monique J. Roobol, Jonas Hugosson, J. Stephen Jones, Michael W. Kattan, Eric Klein, Freddie Hamdy, David Neal, Jenny Donovan, Dipen J. Parekh, Donna Ankerst, George Bartsch, Helmut Klocker, Wolfgang Horninger, Amine Benchikh, Gilles Salama, Arnauld Villers, Steve J. Freedland, Daniel M. MoreiraFritz H. Schröder, Hans Lilja

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71 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)4374-4381
Number of pages8
JournalClinical Cancer Research
Issue number17
StatePublished - Sep 1 2010

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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