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Operating Characteristics of Prostate-Specific Antigen and Verification Bias—Reply
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In Reply: We are pleased that our results, with 65.2% biopsy verification, confirmed the operating characteristics of PSA reported by Dr Punglia and colleagues1 from a study sample with 10.5% verification. While we agree that there is no evidence of violation of the mathematical requirements for applying the Begg and Greenes verification bias adjustment algorithm2 at face value, we do have concerns about this.
With correct inference obtainable from a sample with nearly 90% of the true outcome missing, it is tempting to extend the algorithm of Begg and Greenes, developed initially only for a dichotomous test, to large cohorts with continuous tests from screening studies, which may have few verified samples in the lower range of test results. We are cautious about this extension for 2 reasons. First, a third requirement in Begg and Greenes is a model that accurately predicts probability of disease in the unverified cases. Second, . . . [Full Text of this Article]
Donna Pauler Ankerst, PhD;
Chen Chi, MS
Fred Hutchinson Cancer Research Center
Seattle, Wash
Ian M. Thompson, MD
thompsoni@uthscsa.edu
Division of Urology
University of Texas Health Science Center
San Antonio
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