title: A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Prostate Health Index and 4-Kallikrein Panel Score in Predicting Overall and High-grade Prostate Cancer.
abstract: Markers for prostate cancer (PCa) have progressed over recent years. In particular, the prostate health index (PHI) and the 4-kallikrein (4K) panel have been demonstrated to improve the diagnosis of PCa. We aimed to review the diagnostic accuracy of PHI and the 4K panel for PCa detection. We performed a systematic literature search of PubMed, EMBASE, Cochrane, and Academic One File databases until July 2016. We included diagnostic accuracy studies that used PHI or 4K panel for the diagnosis of PCa or high-grade PCa. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Twenty-eight studies including 16,762 patients have been included for the analysis. The pooled data showed a sensitivity of 0.89 and 0.74 for PHI and 4K panel, respectively, for PCa detection and a pooled specificity of 0.34 and 0.60 for PHI and 4K panel, respectively. The derived area under the curve (AUC) from the hierarchical summary receiver operating characteristic (HSROC) showed an accuracy of 0.76 and 0.72 for PHI and 4K panel respectively. For high-grade PCa detection, the pooled sensitivity was 0.93 and 0.87 for PHI and 4K panel, respectively, whereas the pooled specificity was 0.34 and 0.61 for PHI and 4K panel, respectively. The derived AUC from the HSROC showed an accuracy of 0.82 and 0.81 for PHI and 4K panel, respectively. Both PHI and the 4K panel provided good diagnostic accuracy in detecting overall and high-grade PCa.
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy. Electronic address: giorgioivan@virgilio.it.
authors.forename: Giorgio Ivan
authors.initials: GI
authors.lastname: Russo
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Regis
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Castelli
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Favilla
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Privitera
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Giardina
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cimino
authors.affiliation: Department of Surgery, Urology Section, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006801:Humans; D007610:Kallikreins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D012680:Sensitivity and Specificity
chemical_list: D007610:Kallikreins; C120801:kallikrein 4
keywords: Detection; Diagnosis; Markers; PSA; Prostate biopsy