The Value Of PCA3Test For Prostate Biopsy Decision：a Systematic Review And Meta-analysis

PART I The value of PCA3test for first prostate biopsydecisionObjective The specificity for early interventions of PSA in Prostatecancer is not very well. PCA3can predict biopsy outcomes more accuratelythan PSA for the early detection of prostate cancer. We did a systematicreview of scientific literature and subsequent meta-analysis.Methods A systematic bibliographic search was conducted on theEmbase, Medline, Web of Science, NCBI, PubMed, CNKI and those ofhealth technology assessment agencies published before April2013. Theterms used were “Prostatic Neoplasms”,“prostate”,“‘prostate’,‘carcinoma’ or ‘cancer’ or ‘tumor’, or ‘PCa’.and free terms “upm3”,“pca3”,“dd3”,“aptimapca3”, and “prostate cancer antigen3”. All Patients wereadults. The intervention was to determine the PCA3in urine samples forthe diagnosis of prostate cancer. We checked the quality based on theQUADAS criteria. We collected the data and developed a meta-analysis tosynthesize the results. Twenty-four studies of diagnostic tests withmoderate to high Quality were selected.Results The sensitivity(S) was between46.9%and82.3%, thespecificity (E) from55to92%, the positive predictive value (PPV) had arange of39.0–86%, and the negative predictive value (NPV) was 61–89.7%. The meta-analysis has heterogeneity between studies. Theglobal sensitivity value was0.82[CI0.72–0.90], specificity0.962[CI0.73–0.99], positive likelihood ratio2.39[CI2.10–2.71], the negativelikelihood ratio was0.51[CI0.46–0.86], the diagnostic OR was4.89[CI3.94–6.06], and AUC in SROC curve was0.7441.Conclusions PCA3can be used for early diagnosis of prostate cancerand to avoid unnecessary biopsies. PART Ⅱ The PCA3test for guiding repeat biopsy ofprostate cancer and its cut-off score: asystematic review and meta-analysisObjective The specificity of prostate-specific antigen (PSA) forearly intervention in repeat biopsy is unsatisfactory. PCA3may be moreaccurate in outcome prediction than other methods for the early detectionof prostate cancer. However, the results were inconsistent in repeatedbiopsies. Therefore, we performed a systematic review and meta-analysisto evaluate the role of PCA3in outcome prediction.Methods A systematic bibliographic search was conducted forarticles published before April2013, using PubMed, Medline, Web ofScience, Embase and other databases from health technology assessmentagencies. The quality of the studies was assessed on the basis of QUADAScriteria. Eleven studies of diagnostic tests with moderate to high qualitywere selected. A meta-analysis was carried out to synthesise the results. The results of the meta-analyses were heterogeneous among studies. Weperformed a subgroup analysis (with or without inclusion of high-gradeprostatic intraepithelial neoplasia (HGPIN) and Atypical small acinarproliferation (ASAP)).Results Using a PCA3cut-off of20or35, in the two sub-groups,the global sensitivity values were0.93or0.80and0.79or0.75,specificities were0.65or0.44and0.78VS0.70, positive likelihood ratioswere1.86or1.58and2.49or1.78, negative likelihood ratios were0.81or0.43and0.91or0.82, and diagnostic ORs were5.73or3.45and7.13or4.11. The AUCs of the SROC curve were0.85or0.72and0.81or0.69.Conclusions PCA3can be used for repeat biopsy of the prostate toimprove accuracy of PCA detection; unnecessary biopsies can be avoidedby using a PCA cut-off score of20.