Prostate health index vs %free prostate-specific antigen for prostate cancer detection in men with "gray" prostate-specific antigen levels at first biopsy: Systematic review and meta-analysis - 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 10 ng/mL, measurement of %fPSA (free to total PSA ratio ×100) 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 2-10 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 2-10 ng/mL were included. A total of 8 studies involving 2969 patients with a tPSA range of 2-10 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 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 %freePSA, a relative diagnostic odds ratio of 2.81 (95% CI, 2.19-3.6; P < 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.

Written by:
Bruzzese D, Mazzarella C, Ferro M, Perdonà S, Chiodini P, Perruolo G, Terracciano D.   Are you the author?
Department of Public Health, University "Federico II" Naples, Naples, Italy; Department of Translational Medical Sciences, University "Federico II" Naples, Naples, Italy; Division of Urology, European Institute of Oncology, Milan, Italy; Urology Unit, IRCCS Fondazione G. Pascale, Napoli, Italy; Medical Statistics Unit, Second University of Naples, Naples, Italy.  

Reference: Transl Res. 2014 Jun 26. pii: S1931-5244(14)00213-8.
doi: 10.1016/j.trsl.2014.06.006


PubMed Abstract
PMID: 25035153

UroToday.com Prostate Cancer Section

 

 

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe