Document Type : Systematic Review/ Meta-analysis
Urology Research Center, Tehran University of Medical Sciences, Tehran, IRAN
Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
Department of Internal Medicine, Faculty of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran Iran
Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Purpose: Some tests and markers have proved to improve the diagnosis of prostate cancer (PCa). This meta-analysis aimed to review the diagnostic accuracy of three commercial tests, prostate health index (PHI), prostate cancer antigen3 (PCA3), and prostate imaging – reporting and data system V2 (PI-RADS) for detecting of PCa.
Methods: We did a comprehensive literature search of international databases including Scopus, web of Science and PubMed from January 2000 to Feb 2018. We included three groups of diagnostic accuracy studies that used PCA3, PHI, and PI-RADS to assess PCa. The l quality of study was measured by the Quality Assessment of diagnostic Accuracy Studies (QUADAS-2) criteria.
Results: Twenty-six studies on PHI, 24 articles on PI-RADS, and 26 papers on PCA3 were included for the meta-analysis. For the diagnosis of PCa, the sensitivity and specificity were 0.76 and 0.84 for PI-RADS, 0.48 and 0.85 for PHI, 0.49 and 0.79 for PCA3. Also, the derived area under the curves (AUC) from the hierarchic summary ROCs (HSROCs) were 0.86 (95% CI, 0.83-0.89) for PI-RADS, 0.72 (0.68-0.76) for PCA3, and 0.70 (0.66-0.74) for PHI. Fagan’s nomograms showed that the post-test probability of cancer subjects with a positive test was 53%, 63%, and 45%, for PHI, PI-RADS, and PCA3 respectively.
Conclusions: Currently available evidence suggests that the PI-RADS is superior in the diagnosis of PCa with high sensitivity, specificity, and AUC compared to PHI and PCA3.