Verification Bias and the Prostate-Specific Antigen Test — Is There a Case for a Lower Threshold for Biopsy?

Verification bias can influence the interpretation of the most important screening test for prostate cancer, measurement of prostate-specific antigen (PSA). Such bias arises when the presence or absence of prostate cancer has not been verified by prostate biopsy in all subjects in the screened population. In this issue of the Journal, Punglia et al. report on how verification bias alters the sensitivity and specificity of the PSA test, and how this bias can influence the clinical decision about whether to perform a biopsy of the prostate.1 The problem has been recognized previously,2,3 but Punglia et al. address it with . . .