Abstract
In this study, we performed a comprehensive estimation and assessment for the clinical value of prostate health index (PHI) in diagnosing prostate cancer. Using the bivariate mixed‐effect model, we calculated the following parameters and their 95% confidence internals (CIs), including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and symmetric receiver operator characteristic. Twenty eligible studies with a total number of 5543 subjects were included in the final analysis. The estimated sensitivity was 0.75 (95% CI: 0.70‐0.79) and the specificity was 0.69 (95% CI: 0.58‐0.83). The pooled area under the curve was 0.78 (95% CI: 0.74‐0.81). The combined positive likelihood ratio was 2.45 (95% CI: 2.19‐2.73) and the negative likelihood ratio was 0.36 (95% CI: 0.31‐0.43). The diagnostic odds ratio was 6.73 (95% CI: 5.38‐8.44). The posttest probability was 40% under the present positive likelihood ratio of 2.45. It seems there was no significant difference between Asian population and Caucasian population population in sensitivity and specificity. But the overlap of AUC 95% CI indicated that the diagnostic accuracy of PHI was slightly higher in the Asian population population setting than that in the Caucasian population population population (0.83 vs 0.76). Similarly, there was also overlap in AUC 95% CI, which suggested that sample size may be one of heterogeneity source. The PHI has a moderate diagnostic accuracy for detecting prostate cancer. The discrimination ability of PHI is slightly prior to free/total prostate‐specific antigen. It seems that ethnicity has an influence on the clinical value of PHI in the diagnostic of prostate cancer.
Highlights
Prostate cancer is a common and major cancer of the male genitourinary system and ranks the second among male common malignancy around the world.[1,2] The incidence of prostate cancer in the USA has surpassed that of lung cancer as the first cancer to harm men's health
The pooled results suggested that the prostate health index (PHI) has a moderate diagnostic ability for detecting prostate cancer
The PHI is a comprehensive evaluation index that includes serum total prostate‐specific antigen (PSA), free PSA and −2pro‐PSA (PHI was calculated referring to the following formula [−2]pro‐PSA/fPSA × √PSA).[44]
Summary
Prostate cancer is a common and major cancer of the male genitourinary system and ranks the second among male common malignancy around the world.[1,2] The incidence of prostate cancer in the USA has surpassed that of lung cancer as the first cancer to harm men's health. As the proportion of the population aging and lifestyle changes in China, it is growing faster than other malignant tumors.[5] According to the latest data from the national cancer center in 2008, prostate cancer has surpassed bladder cancer and becomes the most common cancer in the male genitourtinary system.[6] In 2009, its incidence reached 8 out of 100 000, ranking the fifth among male malignant tumors and the mortality rate reached 4.19 out of 100 000, ranking the ninth among all male malignant tumors.[7] Early identification and treatment for patients with prostate cancer seem to be important. We systematically searched the literature and performed a comprehensive estimation and assessment for PHI in detecting prostate cancer
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