title: Improving the evaluation and diagnosis of clinically significant prostate cancer in 2017.
abstract: OBJECTIVE
  To provide an overview of the current state of the evidence and highlight recent advances in the evaluation and diagnosis of clinically significant prostate cancer, focusing on biomarkers, risk calculators and multiparametric MRI (mpMRI).
  
  
  RESULTS
  In 2017 there are numerous options to improve early detection as compared to a purely prostate-specific antigen (PSA)-based approach. All have strengths and drawbacks. In addition to repeating the PSA and performing clinical work-up (digital rectal examination and estimation of prostate volume), additional tests investigated in the initial biopsy setting are: %free PSA, Prostate Health Index, 4-kallikrein score, SelectMDx, and Michigan Prostate Score and in the repeat setting: %free PSA, Prostate Health Index, 4-kallikrein score, Prostate Cancer Antigen 3, and ConfirmMDx. Risk calculators are available for both biopsy settings and incorporate clinical data with, or without, biomarkers. mpMRI is an important diagnostic adjunct.
  
  
  CONCLUSIONS
  There are numerous tests available that can help increase the specificity of PSA, in the initial and repeat biopsy setting. All coincide with a small decrease in sensitivity of detecting high-grade cancer. Cost effectiveness is crucial. The way forward is a multivariable risk assessment on the basis of readily available clinical data, potentially with the addition of PSA subforms, preferably at low cost. MRI in the prediagnostic setting is promising, but is not ready for 'prime time'.
authors.affiliation: aMemorial Sloan Kettering Cancer Center, Departments of Surgery and Epidemiology & Biostatistics, New York, USA bInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden cDepartment of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Sigrid V
authors.initials: SV
authors.lastname: Carlsson
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
mesh_terms: D014408:Biomarkers, Tumor; D001706:Biopsy; D051517:Digital Rectal Examination; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000473:pathology; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D007610:Kallikreins; D017430:Prostate-Specific Antigen