The PCA3 test for guiding repeat biopsy of prostate cancer and its cut-off score: a systematic review and meta-analysis

Abstract

The specificity of prostate-specific antigen (PSA) for early intervention in repeat biopsy is unsatisfactory. Prostate cancer antigen 3 (PCA3) may be more accurate in outcome prediction than other methods for the early detection of prostate cancer (PCa). However, the results were inconsistent in repeated biopsies. Therefore, we performed a systematic review and meta-analysis to evaluate the role of PCA3 in outcome prediction. A systematic bibliographic search was conducted for articles published before April 2013, using PubMed, Medline, Web of Science, Embase and other databases from health technology assessment agencies. The quality of the studies was assessed on the basis of QUADAS criteria. Eleven studies of diagnostic tests with moderate to high quality were selected. A meta-analysis was carried out to synthesize the results. The results of the meta-analyses were heterogeneous among studies. We performed a subgroup analysis (with or without inclusion of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP)). Using a PCA3 cutoff of 20 or 35, in the two sub-groups, the global sensitivity values were 0.93 or 0.80 and 0.79 or 0.75, specificities were 0.65 or 0.44 and 0.78 or 0.70, positive likelihood ratios were 1.86 or 1.58 and 2.49 or 1.78, negative likelihood ratios were 0.81 or 0.43 and 0.91 or 0.82 and diagnostic odd ratios (ORs) were 5.73 or 3.45 and 7.13 or 4.11, respectively. The areas under the curve (AUCs) of the summary receiver operating characteristic curve were 0.85 or 0.72 and 0.81 or 0.69, respectively. PCA3 can be used for repeat biopsy of the prostate to improve accuracy of PCa detection. Unnecessary biopsies can be avoided by using a PCa cutoff score of 20.

The clinical effectiveness and cost-effectiveness of the PROGENSA® prostate cancer antigen 3 assay and the Prostate Health Index in the diagnosis of prostate cancer: a systematic review and economic evaluation

“…Six papers 1,15,66,67,70,110 reporting five systematic reviews and meta-analyses were identified which met the inclusion criteria. As data from within-study comparisons were available, these reviews are summarised for completeness in Table 28.…”

“…Between-study comparisons: summary of systematic reviews Two reviews 66,67,110 assessed the clinical validity of using the PCA3 score to predict prostate cancer. Luo et al 110 considered a repeat biopsy population and included studies without a comparator.…”

“…Luo et al 110 considered a repeat biopsy population and included studies without a comparator. Luo et al…”

“…One previous review 110 of the use of the PCA3 assay in a repeat biopsy population concluded that it was effective in improving accuracy, but the review did not consider its use in combination with other diagnostic tests. A major review 66,67 of the PCA3 assay compared with PSA in a combined population of initial and repeat biopsies concluded that the PCA3 assay improved accuracy but the strength of the evidence reviewed was considered to be low.…”

“…Two systematic reviews assessed the clinical validity of PCA3 scores in the diagnosis of prostate cancer, 66,67,110 two described the effectiveness of MRI-guided biopsies 70,15 and one investigated the effect of systematic protocols for prostate biopsies.…”