ArticleClinical epidemiology2015
Validation of algorithms to detect distant metastases in men with prostate cancer using routine registry data in Denmark.
Article in Clinical epidemiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.
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Who cites it
5 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Diagnostic Performance of Prostate Cancer Disease-Specific Phenotypes Identified Using Real-World Databases: A Systematic Review.Pharmacoepidemiology and drug safety · 2025Pooled it
- A Systematic Review of Estimating Breast Cancer Recurrence at the Population Level With Administrative Data.Journal of the National Cancer Institute · 2020Pooled it
- The Validity of Registered Synchronous Peritoneal Metastases from Colorectal Cancer in the Danish Medical Registries.Clinical epidemiology · 2020Article
- The Danish National Patient Registry: a review of content, data quality, and research potential.Clinical epidemiology · 2015Review
- Validation of International Classification of Diseases coding for bone metastases in electronic health records using technology-enabled abstraction.Clinical epidemiology · 2015Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveAmong patients with prostate cancer, diagnostic codes for bone metastases in the Danish National Registry of Patients have a sensitivity of 44%. In an attempt to improve the sensitivity of registry-based identification of metastases from prostate cancer, we tested a series of algorithms, combining elevated prostate-specific antigen (PSA) levels, use of antiresorptive therapy, and performed bone scintigraphy. PATIENTS AND
methodsWe randomly selected 212 men diagnosed with prostate cancer in 2005-2010 in the Central Denmark Region with prespecified PSA values, antiresorptive therapy, and bone scintigraphy who did not have a registry-based diagnostic code indicating presence of distant metastases. We defined three candidate algorithms for bone metastases: 1) PSA >50 μg/L and bone scintigraphy, 2) PSA >50 μg/L and antiresorptive therapy, and 3) PSA ≤50 μg/L with antiresorptive therapy or bone scintigraphy. An algorithm for distant metastasis site other than bone was defined as PSA >50 μg/L alone. Medical chart review was used as the reference standard to establish the presence or absence of metastases. Validity was expressed as a positive predictive value (PPV) or a negative predictive value, based on whether the algorithms correctly classified metastases compared with the reference standard.
resultsWe identified 113 men with evidence of metastases according to the candidate algorithms, and 99 men without evidence of metastases according to the candidate algorithm. The PPVs of PSA >50 μg/L were 0.10 (95% confidence interval [CI] 0.04-0.19) for bone metastases and 0.14 (95% CI 0.07-0.24) for nonbone metastases, regardless of receipt of antiresorptive therapy or presence of bone scintigraphy. The PPVs for any metastases were 0.16 (95% CI 0.06-0.32) for PSA >50 μg/L and 0.28 (95% CI 0.14-0.47) for PSA >50 μg/L with bone scintigraphy. Adding antiresorptive treatment to the algorithm did not improve PPV. All negative predictive values approached 1.00.
conclusionAlgorithms based on elevated PSA, antiresorptive therapy, or bone scintigraphy are not suitable for supplementing diagnostic codes to identify additional cases of distant metastases among men with prostate cancer. However, it is possible that in this setting, medical chart review is not a gold standard to identify metastases.
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