title: [The level of evidence for the use of biomarkers in the early detection of prostate cancer].
abstract: To systematically review the evidence for the use of PSA and other biomarkers in the early detection of prostate cancer, we searched PubMed for clinical trials and studies assessing PSA and other biomarkers in the early detection of prostate cancer, published between 2000 and May 2013 that included >200 subjects. The level of evidence (LOE) for clinical utility was evaluated using the tumor marker utility grading system. A total of 84 publications, corresponding to 70 trials and studies were selected for inclusion in this review. We attributed a level of evidence (LoE) of IA to PSA for early PCa detection, but we do not recommend its use in mass screening. Emerging biomarkers were assessed in prospective case-control and cohort studies: PCA3 (n=3); kallikreins (n=3); [-2]proPSA (n=5); fusion oncogenes (n=2). These studies used biopsy results for prostate cancer to determine specificity and sensitivity, but they did not assess the effect on PCa mortality. The LoE attributed was III-C. PSA can be used for early prostate cancer detection but mass screening is not recommended. Studies on other biomarkers suggest that they could be used, individually or in combination, to improve the selection of patients with elevated PSA levels for biopsy, but RCTs assessing their impact on prostate cancer management and mortality are needed. A better use of available tests is possible for men at risk in order to maximize the risk-benefit ratio.
authors.affiliation: Unité de recherche clinique , Clinique Beau Soleil, Montpellier, France, Institut médical d'analyse génomique, Labosud-Ocbiologie, Montpellier, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Lamy
authors.affiliation: Institut de biologie et de pathologie, CHU Grenoble, UMR-S Inserm 1039, Grenoble, France, Groupe de biologie spécialisée, Société française de médecine nucléaire, Paris, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Gauchez
authors.affiliation: Service d'urologie, APHP CHU Henri Mondor, Créteil, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.affiliation: MediCom Consult, Villeurbanne, France.
authors.forename: Margaret
authors.initials: M
authors.lastname: Haugh
authors.affiliation: UMR_S 1113, FMTS, Université de Strasbourg, Strasbourg, France.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Ceraline
authors.affiliation: Groupe de biologie spécialisée, Société française de médecine nucléaire, Paris, France.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Fulla
authors.affiliation: Médecine nucléaire, CHU Bordeaux, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Georges
authors.affiliation: Service d'urologie, CHU de Reims, Reims, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Larré
authors.affiliation: Biochimie clinique et génétique, APHP CHU Créteil, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Loric
authors.affiliation: Service d'oncologie, Centre Alexis Vautrin, Nancy, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Luporsi
authors.affiliation: Laboratoire de transfert d'oncologie biologie, APHM, Marseille, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Martin
authors.affiliation: Laboratoire d'anatomie et cytologie pathologiques, IUCT Oncopole 1, Toulouse, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mazerolles
authors.affiliation: Laboratoire d'anatomie et cytologie pathologiques, CHU La Meynard Fort de France, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Molinié
authors.affiliation: Service d'urologie, APHP, CHU Saint-Louis, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mongiat-Artus
authors.affiliation: Association française d'urologie, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Piffret
authors.affiliation: Société française de biologie clinique et Collège national de biochimie des Hôpitaux Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Thuillier
authors.affiliation: Service d'urologie, Hôpital Lyon-Sud, Hospices Civils de Lyon, Lyon.
authors.forename: Paul
authors.initials: P
authors.lastname: Perrin
authors.affiliation: Service d'urologie, Clinique Beau Soleil, Montpellier, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Rebillard
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis* / Q000097:blood; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D017430:Prostate-Specific Antigen / Q000032:analysis / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: PSA; cancer; detection; level of evidence; prostate; tumor markers