Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
6155867 | Translational Research | 2014 | 8 Pages |
Abstract
The most promising approach to improve the specificity of prostate-specific antigen (PSA) test relies on the measurement of different molecular isoforms of PSA in serum. Currently, in men with a total PSA (tPSA) level between 2 and 10Â ng/mL, measurement of %fPSA (free to total PSA ratio Ã100) is used as reflex testing to better distinguish between malignant and benign prostate disease. Recently, Beckman Coulter developed the prostate health index (PHI) and several studies suggested that this test may improve the diagnostic ability of %fPSA.We performed a meta-analysis to evaluate the usefulness of PHI compared with %fPSA in the detection of prostate cancer (PCa) at first biopsy in men with tPSA “gray” levels of 2-10Â ng/mL. Data on sensitivity and specificity were extracted from 8 eligible studies. Only observational studies comparing the diagnostic ability of PHI and %fPSA in tPSA range of 2-10Â ng/mL were included. A total of 8 studies involving 2969 patients with a tPSA range of 2-10Â ng/mL undergoing first biopsy were included in this meta-analysis. Biopsy-confirmed PCa was detected in 1287 (43.3%) men. Selected studies determined both PHI and %fPSA as a reflex test. The areas under curve (AUCs) of PHI and %fPSA were 0.74 (95% confidence interval [CI], 0.70-0.77) and 0.63 (95% CI, 0.58-0.67), respectively. Meta-regression analysis confirmed the superiority of PHI which showed, compared with %fPSA, a relative diagnostic odds ratio of 2.81 (95% CI, 2.19-3.6; PÂ <Â 0.0001). In conclusion, PHI instead of %fPSA as a reflex test in men with tPSA “gray” levels is a better predictor of positive first biopsy and can offer a reduction in unnecessary biopsies.
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Authors
Dario Bruzzese, Claudia Mazzarella, Matteo Ferro, Sisto Perdonà , Paolo Chiodini, Giuseppe Perruolo, Daniela Terracciano,