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February 1, 1985, Vol 253, No. 5 >
ARTICLE | February 1, 1985

Diagnostic Accuracy of Four Assays of Prostatic Acid Phosphatase: Title and subTitle BreakComparison Using Receiver Operating Characteristic Curve Analysis FREE

Jeffrey L. Carson, MD; John M. Eisenberg, MD; Leslie M. Shaw, PhD; Harold L. Kundel, MD; Keith A. Soper, MA
[+] Author Affiliations

Reprint requests to Department of Medicine, UMDNJ/Rutgers Medical School at Camden, Cooper Hospital/University Medical Center, 1 Cooper Plaza, Camden, NJ 08103 (Dr Carson).


JAMA. 1985;253(5):665-669. doi:10.1001/jama.1985.03350290071028
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References

We compared the diagnostic characteristics of four assays of prostatic acid phosphatase by two methods. In the first analysis, receiver operating characteristic (ROC) curves were developed and the areas under the curves were calculated. In the second analysis, the sensitivity of each assay was compared with the sensitivities of the other assays with specificities set at equal levels. One or more assays were performed in 1,298 patients; 141 underwent all four assays. Pairwise comparisons of the areas under the ROC curves showed no significant differences. No differences were found in the sensitivities of the four assays when the upper limits of normal were selected to provide equal specificities. We conclude that there is little difference in diagnostic accuracy among the prostatic acid phosphatase assays. Our findings contrast with previous studies that used only one upper limit of normal and that found some assays to be superior to others. Receiver operating characteristic curve analysis corrects for the bias introduced by the choice of an upper limit of normal.

(JAMA 1985;253:665-669)

REFERENCES

1 +
Gutman AB, Gutman ED:  An acid phosphatase occurring in the serum of patients with metastasizing carcinoma of the prostate gland . J Clin Invest 1938;;17:473-476.
2 +
Gittes R:  Acid phosphatase reappraised . N Engl J Med 1977;;297:1398-1399.
3 +
Romas NA, Rose NR, Tannebaum M:  Acid phosphatase: New developments . Hum Pathol 1979;;10:501-512.
4 +
Murphy GP, Karr J, Chu TM:  Prostatic acid phosphatase: Where are we? CA 1978;;28:258-264.
5 +
Choe BK, Rose NR, Kaorl M, et al:  Immunoenzyme assay for human prostatic acid phosphatase . Proc Soc Exp Biol Med 1979;;162:396-400.
6 +
McNeil BJ, Keeler E, Adelstein SJ:  Primer on certain elements of medical decision making . N Engl J Med 1975;;293:211-215.
7 +
Weinstein MC, Fineberg HV, Elstein AS, et al: Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;, pp 84-85.
8 +
Griner PF, Mayewski RJ, Mushlin AI, et al:  Selection and interpretation of diagnostic tests and procedures . Ann Intern Med 1981;;94:453-600.
9 +
Metz CE:  Basic principles of ROC analysis . Semin Nucl Med 1978;;8:283-298.
10 +
Erdreich LS, Lee ET:  Use of relative operating characteristic analysis in epidemiology . Am J Epidemiol 1981;;114:649-662.
11 +
Swets JA:  ROC analysis applied to the evaluation of medical imaging techniques . Invest Radiol 1979;;14:109-121.
12 +
Romas NA, Shaw LM, Hsu RC, et al:  Clinical comparison of immunological assays for determining prostatic acid phosphatase . Ann NY Acad Sci 1982;;390:104-109.
13 +
Lindholm GR, Stirton MS, Liedtke RJ, et al:  Prostatic acid phosphatase by radioimmunoassay . JAMA 1980;;244:2071-2073.
14 +
Shaw LM, Yang N, Brooke JJ, et al:  Immunochemical evaluation of the organ specificity of prostatic acid phosphatase . Clin Chem 1981;;27:1505-1512.
15 +
Hunter WM, Greenwood FC:  Preparation of iodine 131 labeled human growth hormone of high specific activity . Nature 1962;;94:495.
16 +
Roy AV, Bouer ME, Hayden R:  Sodium thymolphthalein monophosphate: A new acid phosphatase substrate with greater specificity for the prostatic enzyme in serum . Clin Chem 1971;;17:1093-1102.
17 +
Romas NA, Hsu KC, Tomashefsky P, et al:  Counterimmunoelectrophoresis for detection of human prostatic acid phosphatase . Urology 1978;; 12:79-83.
18 +
Williams CA, Chase MW (eds): Methods of Immunology and Immunochemistry . New York, Academic Press Inc, 1967;, vol 2, p 162.
19 +
Whitemore WF:  Symposium on hormones and cancer therapy in prostatic cancer . Am J Med 1956;;21:697-713.
20 +
Hanley JA, McNeil BJ:  The meaning and use of the area under the receiver operating characteristic curve . Radiology 1982;;143:29-36.
21 +
Swets JA, Pickett RM: Evaluation of Diagnostic Systems . New York, Academic Press Inc, 1982;.
22 +
Weiner BJ:  Design and analysis of singlefactor experiments , in Weiner BJ (ed): Statistical Principles in Experimental Design . New York, McGraw-Hill Book Co, 1971;, pp 147-177, 220-223.
23 +
Metz CE, Kronan HB:  Statistical significance tests for binormal ROC curves . J Math Psych 1980;;22:218-243.
24 +
Hanley JA, McNeil BJ:  Comparing ROC curves derived from the same sample of patients . Radiology 1983;;148:839-843.
25 +
Siegal S:  The case of two related samples , in Siegal S (ed): Nonparametric Statistics . New York, McGraw-Hill Book Co, 1956;, pp 63-67.
26 +
Schlesselman JJ:  Sample size , in Schlesselman JJ (ed): Case Control Studies . Oxford, England, Oxford University Press, 1982;, pp 144-154.
27 +
Schlesselman JJ:  Basic methods of analysis , in Schlesselman JJ (ed): Case Control Studies . Oxford, England, Oxford University Press, 1982;, pp 183-190.
28 +
Foti AG, Cooper JF, Hershman H, et al:  Detection of prostatic cancer by solid-phase radioimmunoassay of serum prostatic acid phosphatase . N Engl J Med 1977;;297:1357-1361.
29 +
Griffith JC:  Prostatic specific acid phosphatase: Re-evaluation of radioimmunoassay in diagnosing prostatic disease . Clin Chem 1980;; 26:433-436.
30 +
Mahan DE, Doctor BP:  A radioimmune assay for human prostatic acid phosphatase levels in prostatic disease . Clin Biochem 1979;; 12:10-17.
31 +
Guinan P, Bush I, Ray V, et al:  The accuracy of the rectal examination in the diagnosis of prostatic carcinoma . N Engl J Med 1980;;303:499-503.
32 +
Huber PR, Scholer A, Linder E, et al:  Measurement of prostatic acid phosphatase in serum and bone marrow: Radioimmunoassay and enzymic measurement compared . Clin Chem 1982;;28:2044-2050.
33 +
Chu TH, Wang MC, Scott WW, et al:  Immunochemical detection of serum prostatic acid phosphatase: Methodology and clinical evaluation . Invest Urol 1978;;15:319-323.
34 +
Ransohoff DF, Feinstein AR:  Problems of spectrum and bias in the efficacy of diagnostic tests . N Engl J Med 1978;;299:926-930.
35 +
Gittes RI:  Serum acid phosphatase and screening for carcinoma of the prostate . N Engl J Med 1983;;309:852-853.

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1 +
Gutman AB, Gutman ED:  An acid phosphatase occurring in the serum of patients with metastasizing carcinoma of the prostate gland . J Clin Invest 1938;;17:473-476.
2 +
Gittes R:  Acid phosphatase reappraised . N Engl J Med 1977;;297:1398-1399.
3 +
Romas NA, Rose NR, Tannebaum M:  Acid phosphatase: New developments . Hum Pathol 1979;;10:501-512.
4 +
Murphy GP, Karr J, Chu TM:  Prostatic acid phosphatase: Where are we? CA 1978;;28:258-264.
5 +
Choe BK, Rose NR, Kaorl M, et al:  Immunoenzyme assay for human prostatic acid phosphatase . Proc Soc Exp Biol Med 1979;;162:396-400.
6 +
McNeil BJ, Keeler E, Adelstein SJ:  Primer on certain elements of medical decision making . N Engl J Med 1975;;293:211-215.
7 +
Weinstein MC, Fineberg HV, Elstein AS, et al: Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;, pp 84-85.
8 +
Griner PF, Mayewski RJ, Mushlin AI, et al:  Selection and interpretation of diagnostic tests and procedures . Ann Intern Med 1981;;94:453-600.
9 +
Metz CE:  Basic principles of ROC analysis . Semin Nucl Med 1978;;8:283-298.
10 +
Erdreich LS, Lee ET:  Use of relative operating characteristic analysis in epidemiology . Am J Epidemiol 1981;;114:649-662.
11 +
Swets JA:  ROC analysis applied to the evaluation of medical imaging techniques . Invest Radiol 1979;;14:109-121.
12 +
Romas NA, Shaw LM, Hsu RC, et al:  Clinical comparison of immunological assays for determining prostatic acid phosphatase . Ann NY Acad Sci 1982;;390:104-109.
13 +
Lindholm GR, Stirton MS, Liedtke RJ, et al:  Prostatic acid phosphatase by radioimmunoassay . JAMA 1980;;244:2071-2073.
14 +
Shaw LM, Yang N, Brooke JJ, et al:  Immunochemical evaluation of the organ specificity of prostatic acid phosphatase . Clin Chem 1981;;27:1505-1512.
15 +
Hunter WM, Greenwood FC:  Preparation of iodine 131 labeled human growth hormone of high specific activity . Nature 1962;;94:495.
16 +
Roy AV, Bouer ME, Hayden R:  Sodium thymolphthalein monophosphate: A new acid phosphatase substrate with greater specificity for the prostatic enzyme in serum . Clin Chem 1971;;17:1093-1102.
17 +
Romas NA, Hsu KC, Tomashefsky P, et al:  Counterimmunoelectrophoresis for detection of human prostatic acid phosphatase . Urology 1978;; 12:79-83.
18 +
Williams CA, Chase MW (eds): Methods of Immunology and Immunochemistry . New York, Academic Press Inc, 1967;, vol 2, p 162.
19 +
Whitemore WF:  Symposium on hormones and cancer therapy in prostatic cancer . Am J Med 1956;;21:697-713.
20 +
Hanley JA, McNeil BJ:  The meaning and use of the area under the receiver operating characteristic curve . Radiology 1982;;143:29-36.
21 +
Swets JA, Pickett RM: Evaluation of Diagnostic Systems . New York, Academic Press Inc, 1982;.
22 +
Weiner BJ:  Design and analysis of singlefactor experiments , in Weiner BJ (ed): Statistical Principles in Experimental Design . New York, McGraw-Hill Book Co, 1971;, pp 147-177, 220-223.
23 +
Metz CE, Kronan HB:  Statistical significance tests for binormal ROC curves . J Math Psych 1980;;22:218-243.
24 +
Hanley JA, McNeil BJ:  Comparing ROC curves derived from the same sample of patients . Radiology 1983;;148:839-843.
25 +
Siegal S:  The case of two related samples , in Siegal S (ed): Nonparametric Statistics . New York, McGraw-Hill Book Co, 1956;, pp 63-67.
26 +
Schlesselman JJ:  Sample size , in Schlesselman JJ (ed): Case Control Studies . Oxford, England, Oxford University Press, 1982;, pp 144-154.
27 +
Schlesselman JJ:  Basic methods of analysis , in Schlesselman JJ (ed): Case Control Studies . Oxford, England, Oxford University Press, 1982;, pp 183-190.
28 +
Foti AG, Cooper JF, Hershman H, et al:  Detection of prostatic cancer by solid-phase radioimmunoassay of serum prostatic acid phosphatase . N Engl J Med 1977;;297:1357-1361.
29 +
Griffith JC:  Prostatic specific acid phosphatase: Re-evaluation of radioimmunoassay in diagnosing prostatic disease . Clin Chem 1980;; 26:433-436.
30 +
Mahan DE, Doctor BP:  A radioimmune assay for human prostatic acid phosphatase levels in prostatic disease . Clin Biochem 1979;; 12:10-17.
31 +
Guinan P, Bush I, Ray V, et al:  The accuracy of the rectal examination in the diagnosis of prostatic carcinoma . N Engl J Med 1980;;303:499-503.
32 +
Huber PR, Scholer A, Linder E, et al:  Measurement of prostatic acid phosphatase in serum and bone marrow: Radioimmunoassay and enzymic measurement compared . Clin Chem 1982;;28:2044-2050.
33 +
Chu TH, Wang MC, Scott WW, et al:  Immunochemical detection of serum prostatic acid phosphatase: Methodology and clinical evaluation . Invest Urol 1978;;15:319-323.
34 +
Ransohoff DF, Feinstein AR:  Problems of spectrum and bias in the efficacy of diagnostic tests . N Engl J Med 1978;;299:926-930.
35 +
Gittes RI:  Serum acid phosphatase and screening for carcinoma of the prostate . N Engl J Med 1983;;309:852-853.

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