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Volume 16, Issue 3 (May 2014) 16, 487–492; 10.4103/1008-682X.125390

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

Yong Luo, Xin Gou, Peng Huang , Chan Mou

The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Correspondence: Dr. X Gou (gouxincq@163.com)

Received: 22 June 2013; Revised: 17 July 2013; Accepted: 26 September 2013


The specificity of prostate-specific antigen (PSA) for early intervention in repeat biopsy is unsatisfactory. PCA3 may be more accurate in outcome prediction than other methods for the early detection of prostate cancer. 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 synthesise 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 cut-off 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 ORs were 5.73 or 3.45 and 7.13 or 4.11. The AUCs of the SROC curve were 0.85 or 0.72 and 0.81 or 0.69. PCA3 can be used for repeat biopsy of the prostate to improve accuracy of PCA detection. innecessary biopsies can be avoided by using a PCA cut-off score of 20.

Keywords: meta‑analysis; PCA3; prostate cancer; repeat biopsy; systematic review

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