Accuracy of Screening Tests

The sensitivity and specificity of prostate-specific antigen (PSA) depend on the threshold set for a clinically significant abnormal value. Using the cutoff of 4.0 ng/mL has an estimated sensitivity of 63% to 83% and a specificity about 90% in the first screening. Sensitivity decreases with increasing age and the presence of benign prostatic hyperplasia. DRE evaluates only the posterior and lateral aspects of the prostate, has poor interoperator agreement, and detects less than 60% of prostate cancers (Harris et al., 2001). The combination of DRE with PSA increases the sensitivity but also increases the rate of false-positive results.

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