Risk-stratified multi-round PSA screening for prostate cancer integrating the screening reference level and subgroup-specific progression indicators

Table 2 Comparison of screening performances between different screening strategies

Methods	Cases	Non-cases	Total	Sensitivity		Specificity		PPV		NPV
Methods	Cases	Non-cases	Total	%	P	%	P	%	P	%	P
Traditional PSA screening (positive screen defined as any PSA > 4 ng/ml)
Positive	754	1330	2084	21.6	Ref.	96.3	Ref.	46.2	Ref.	90.9	Ref.
Negative	2730	27,128	29,858
Total	3484	28,458	31,942
Optimized strategy 1 (positive screen defined as any PSA > 1.61 ng/ml)
Positive	2564	8015	10,579	73.6	< 0.001	71.8	< 0.001	24.2	< 0.001	95.7	< 0.001
Negative	920	20,443	21,363
Total	3484	28,458	31,942
Optimized strategy 2 (positive screen included all positive screen in optimized strategy 1 and any subgroup-specific positive progression)^†
Positive	3283	14,426	17,709	94.2	< 0.001	49.3	< 0.001	18.5	< 0.001	98.6	< 0.001
Negative	201	14,032	14,233
Total	3484	28,458	31,942
Optimized strategy 3 (positive screen excluded low-risk positive screen in optimized strategy 2)^‡
Positive	1881	2809	4690	54.0	< 0.001	90.1	< 0.001	40.1	< 0.001	94.1	< 0.001
Negative	1603	25,649	27,252
Total	3484	28,458	31,942

PPV: †, subgroup-specific positive progression including positive progression in subgroups with stable negative PSA[(FR(−)/LR(−)], gain of positive PSA[(FR(−)/LR(+)], and stable positive PSA[(FR(+)/LR(+)]; ‡, low-risk positive screen in optimized strategy 2 included positive screen in the subgroup with loss of positive PSA [(FR(+)/LR(−)] and positive progression in subgroup with stable negative PSA[(FR(−)/LR(−)]. PPV, positive predictive value; NPV: negative predictive value

ISSN: 2047-783X