Comparison on Diagnostic Accuracy of Prostate Cancer Detection Tools: A Systematic Review and Meta-Analysis

Introduction 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 antigen 3 (PCA3), and prostate imaging reporting 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 the 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 in 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, and 0.49 and 0.79 for PCA3. Also, the derived area under 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.ConclusionsAvailable evidence suggests that the PI-RADS is superior in diagnosing PCa with high sensitivity, specificity, and AUC compared to PHI and PCA3.