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               <mods:name>
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                  <mods:namePart>Smith-Byrne, Karl</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Fensom, Georgina K.</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Noor, Urwah</mods:namePart>
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               <mods:name>
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                     <mods:roleTerm type="text">author</mods:roleTerm>
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                  <mods:namePart>Watts, Eleanor L.</mods:namePart>
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               <mods:name>
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                  </mods:role>
                  <mods:namePart>Allen, Naomi E.</mods:namePart>
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               <mods:name>
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                     <mods:roleTerm type="text">author</mods:roleTerm>
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                  <mods:namePart>Amiano, Pilar</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Chirlaque, María Dolores</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Crous Bou, Marta</mods:namePart>
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               <mods:name>
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                     <mods:roleTerm type="text">author</mods:roleTerm>
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                  <mods:namePart>Guevara Eslava, Marcela</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Palli, Domenico</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Katzke, Verena</mods:namePart>
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               <mods:name>
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                     <mods:roleTerm type="text">author</mods:roleTerm>
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                  <mods:namePart>Sacerdote, Carlotta</mods:namePart>
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               <mods:name>
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                     <mods:roleTerm type="text">author</mods:roleTerm>
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                  <mods:namePart>Sánchez Pérez, María José</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Schulze, Matthias B.</mods:namePart>
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                  <mods:namePart>Sieri, Sabina</mods:namePart>
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                  <mods:namePart>Tumino, Rosario</mods:namePart>
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                  <mods:namePart>Tsilidis, Konstantinos K.</mods:namePart>
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                  <mods:namePart>Kaaks, Rudolf</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Gunter, Marc J.</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Riboli, Elio</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Key, Timothy J.</mods:namePart>
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               <mods:name>
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                  <mods:namePart>Travis, Ruth C.</mods:namePart>
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                  <mods:dateIssued encoding="iso8601">2025-11-27T14:07:35Z2025-11-27T14:07:35Z2025-08-222025-11-27T11:24:28Z</mods:dateIssued>
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               <mods:abstract>Background: PSA is central to referrals for prostate biopsy but has low specificity for aggressive prostate cancer. This study evaluates the 4Kscore (OPKO Diagnostics) versus total PSA in predicting short- and long-term risks of aggressive prostate cancer. Methods: Baseline blood samples from 1,658 men diagnosed with prostate cancer (median diagnosis time = 8.6 years) and 1,658 matched controls in the European Prospective Investigation into Cancer and Nutrition were analyzed. Discrimination for the 4Kscore and total PSA was assessed using the AUC with 95% confidence intervals (CI) via bootstrapping. Results: For high-grade tumors, AUCs were 0.69 (95% CI, 0.66-0.72) for the 4Kscore and 0.75 (95% CI, 0.73-0.78) for total PSA. For advanced-stage disease, AUCs were 0.71 (95% CI, 0.66-0.75) for the 4Kscore and 0.77 (95% CI, 0.73-0.80) for total PSA. Similar findings were observed for other aggressive cancer endpoints. Among men with PSA >2 ng/mL, the 4Kscore had better discrimination than PSA for overall prostate cancer, high-grade disease, and prostate cancer death but only in men &lt;60 years at recruitment. Conclusions: In this large European study, the 4Kscore did not significantly improve the prediction of clinically significant prostate cancer compared with total PSA, except in younger men with elevated PSA. Impact: The findings underscore the limited utility of the 4Kscore in improving medium- to longer-term risk prediction over PSA, with potential benefits restricted to younger men with elevated PSA.</mods:abstract>
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               <mods:accessCondition type="useAndReproduction">cc-by (c) Smith-Byrne, Karl et al., 2025 http://creativecommons.org/licenses/by/3.0/es/ info:eu-repo/semantics/openAccess</mods:accessCondition>
               <mods:subject>
                  <mods:topic>Càncer de pròstata</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Antigen específic de la pròstata</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Prostate cancer</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Prostate-specific antigen</mods:topic>
               </mods:subject>
               <mods:titleInfo>
                  <mods:title>Evaluation of the 4Kscore Test in Relation to Subsequent Risk of Aggressive Prostate Cancer in the European Prospective Investigation into Cancer and Nutrition</mods:title>
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