***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE In patients with a negative prostate biopsy and persistent suspicion of prostate cancer , additional analyses such as the PCA3 score , PHI and multiparametric magnetic resonance imaging have been proposed to reduce the number of unnecessary repeat biopsies . In this study we evaluate the diagnostic accuracy of PCA3 , PHI , multiparametric magnetic resonance imaging and various combinations of these tests in the repeat biopsy setting . MATERIAL S AND METHODS A total of 170 patients with an initial negative prostate biopsy and persistent suspicion of prostate cancer were enrolled in this prospect i ve study . The patients underwent measurements of the total prostate specific antigen and free prostate specific antigen rate , along with PHI , PCA3 tests and multiparametric magnetic resonance imaging before st and ard repeat biopsy that was performed by urologists blinded to the multiparametric magnetic resonance imaging results . Multivariate logistic regression models with various combinations of PCA3 , PHI and multiparametric magnetic resonance imaging were used to identify the predictors of prostate cancer with repeat biopsy , and the performance of these models was compared using ROC curves , AUC analysis and decision curve analysis . RESULTS In the ROC analysis the most significant contribution was provided by multiparametric magnetic resonance imaging ( AUC 0.936 ) , which was greater than the contribution of the PHI+PCA3 model ( p < 0.001 ) . In the multivariate logistic regression analysis only multiparametric magnetic resonance imaging was a significant independent predictor of prostate cancer diagnosis with repeat biopsy ( p < 0.001 ) . The results of the decision curve analysis confirmed that the most significant improvement in the net benefit was provided by multiparametric magnetic resonance imaging . CONCLUSIONS Multiparametric magnetic resonance imaging provides high diagnostic accuracy in identifying patients with prostate cancer in the repeat biopsy setting compared with PCA3 and PHI PURPOSE We tested the hypothesis that serum isoform [-2]proPSA derivatives % p2PSA and Prostate Health Index are accurate predictors of prostate cancer in men scheduled for repeat biopsy . MATERIAL S AND METHODS The study was an observational prospect i ve evaluation of a clinical cohort of men with 1 or 2 previous negative prostate biopsies , with persistent suspicion of prostate cancer . They were enrolled in the study to determine the diagnostic accuracy of % p2PSA using the formula , ( p2PSA pg/ml)/(free prostate specific antigen ng/ml × 1,000)] × 100 , and Beckman-Coulter Prostate Health Index using the formula , ( p2PSA/free prostate specific antigen ) × √total prostate specific antigen ) , and to compare it with the accuracy of established prostate cancer serum tests ( total prostate specific antigen , free prostate specific antigen and percent free prostate specific antigen ) . Multivariable logistic regression models were complemented by predictive accuracy analysis and decision curve analysis . RESULTS Prostate cancer was found in 71 of 222 ( 31.9 % ) subjects .  % p2PSA and Prostate Health Index were the most accurate predictors of disease . % p2PSA significantly outperformed total prostate specific antigen , free prostate specific antigen , percent free prostate specific antigen and p2PSA in the prediction of prostate cancer ( p ≤0.01 ) , but not Prostate Health Index ( p = 0.094 ) . Prostate Health Index significantly outperformed total prostate specific antigen and p2PSA ( p ≤0.001 ) but not free prostate specific antigen ( p = 0.109 ) and free/total prostate specific antigen ( p = 0.136 ) . In multivariable logistic regression models % p2PSA and Prostate Health Index achieved independent predictor status , and significantly increased the accuracy of multivariable models including prostate specific antigen and prostate volume with or without percent free prostate specific antigen and prostate specific antigen density by 8 % to 11 % ( p ≤0.034 ) . At a % p2PSA cutoff of 1.23 , 153 ( 68.9 % ) biopsies could have been avoided , missing prostate cancer in 6 patients . At a Prostate Health Index cutoff of 28.8 , 116 ( 52.25 % ) biopsies could have been avoided , missing prostate cancer in 6 patients . CONCLUSIONS Serum % p2PSA and Prostate Health Index are more accurate than st and ard reference tests in predicting repeat prostate biopsy outcome , and could avoid unnecessary repeat biopsies Study Type – Diagnosis ( exploratory cohort ) Prostate cancer is the most common noncutaneous malignancy and the second leading cause of cancer death in men . In the United States , 90 % of men with prostate cancer are more than age 60 years , diagnosed by early detection with the prostate-specific antigen ( PSA ) blood test , and have disease believed confined to the prostate gl and ( clinical ly localized ) . Common treatments for clinical ly localized prostate cancer include watchful waiting ( WW ) , surgery to remove the prostate gl and ( radical prostatectomy ) , external-beam radiation therapy and interstitial radiation therapy ( brachytherapy ) , and and rogen deprivation . Little is known about the relative effectiveness and harms of treatments because of the paucity of r and omized controlled trials . The Department of Veterans Affairs/National Cancer Institute/Agency for Healthcare Research and Quality Cooperative Studies Program Study # 407:Prostate Cancer Intervention Versus Observation Trial ( PIVOT ) , initiated in 1994 , is a multicenter r and omized controlled trial comparing radical prostatectomy with WW in men with clinical ly localized prostate cancer . We describe the study rationale , design , recruitment methods , and baseline characteristics of PIVOT enrollees . We provide comparisons with eligible men declining enrollment and men participating in another recently reported r and omized trial of radical prostatectomy vs WW conducted in Sc and inavia . We screened 13 022 men with prostate cancer at 52 US medical centers for potential enrollment . From these , 5023 met initial age , comorbidity , and disease eligibility criteria , and a total of 731 men agreed to participate and were r and omized . The mean age of enrollees was 67 years . Nearly one-third were African American . Approximately 85 % reported that they were fully active . The median PSA was 7.8ng/mL ( mean 10.2ng/mL ) . In three-fourths of men , the primary reason for biopsy leading to a diagnosis of prostate cancer was a PSA elevation or rise . Using previously developed tumor risk categorizations incorporating PSA levels , Gleason histologic grade , and tumor stage , it was found that approximately 40 % had low-risk , 34 % had medium-risk , and 21 % had high-risk prostate cancer based on local histopathology . Comparison to our national sample of eligible men declining PIVOT participation as well as to men enrolled in the Sc and inavian trial indicated that PIVOT enrollees are representative of men being diagnosed and treated in the United States and quite different from men in the Sc and inavian trial . PIVOT enrolled an ethnically diverse population representative of men diagnosed with prostate cancer in the United States . Results will yield important information regarding the relative effectiveness and harms of  surgery  compared with WW for men with predominately PSA-detected clinical ly localized prostate cancer BACKGROUND The Prostate CAncer gene 3 ( PCA3 ) assay has shown promise as an aid in prostate cancer ( pCA ) diagnosis in identifying men with a high probability of a positive ( repeat ) biopsy . OBJECTIVE This study evaluated the clinical utility of the PROGENSA PCA3 assay . DESIGN , SETTING , AND PARTICIPANTS This European prospect i ve , multicentre study enrolled men with one or two negative biopsies scheduled for repeat biopsy . MEASUREMENTS After digital rectal examination ( DRE ) , first-catch urine was collected to measure PCA3 mRNA concentration and to calculate the PCA3 score . The PCA3 score was compared to biopsy outcome . The diagnostic accuracy of the PCA3 assay was compared to percent of free prostate-specific antigen ( % fPSA ) . RESULTS AND LIMITATIONS In 463 men , the positive repeat biopsy rate was 28 % . The higher the PCA3 score , the greater the probability of a positive repeat biopsy . The PCA3 score ( cut-off of 35 ) had a greater diagnostic accuracy than % fPSA ( cut-off of 25 % ) . The PCA3 score was independent of the number of previous biopsies , age , prostate volume , and total prostate-specific antigen ( PSA ) level . Moreover , the PCA3 score was significantly higher in men with high- grade prostate intraepithelial neoplasia ( HGPIN ) versus those without HGPIN , clinical stage T2 versus T1 , Gleason score > or=7 versus < 7 , and " significant " versus " indolent " ( clinical stage T1c , PSA density [ PSAD ] < 0.15ng/ml , Gleason score in biopsy < or=6 , and percent positive cores < or=33 % ) pCA . CONCLUSIONS The probability of a positive repeat biopsy increases with rising PCA3 scores . The PCA3 score was superior to % fPSA for predicting repeat prostate biopsy outcome and may be indicative of clinical stage and significance of pCa Background : Identification of men harbouring insignificant prostate cancer ( PC ) is important in selecting patients for active surveillance . Tools have been developed in PSA-screened population s to identify such men based on clinical and biopsy parameters . Methods : Prospect ively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre .  Tumour volume was assessed by pathological examination . For each tool , receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared . Comparison of accuracy in screened and unscreened population s was performed . Results : Of 848 patients , 415 had Gleason 3 + 3 disease on biopsy . Of these , 32.0 % had extra-prostatic extension and 50.2 % were up grade d. One had positive lymph nodes . Two hundred and six ( 24 % of cohort ) were D’Amico low risk . Of these , 143 had more than two biopsy cores involved . None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden . Accuracy is low in PSA-screened and -unscreened population s. Conclusions : In our unscreened population , tools design ed to identify insignificant PC are inaccurate . Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy BACKGROUND After 11 years of follow-up , the European R and omized Study of Screening for Prostate Cancer ( ERSPC ) reported a 29 % reduction in prostate-cancer mortality among men who underwent screening for prostate-specific antigen ( PSA ) levels .  However , the extent to which harms to quality of life result ing from overdiagnosis and treatment counterbalance this benefit is uncertain . METHODS On the basis of ERSPC follow-up data , we used Microsimulation Screening Analysis ( MISCAN ) to predict the number of prostate cancers , treatments , deaths , and quality -adjusted life-years ( QALYs ) gained after the introduction of PSA screening . Various screening strategies , efficacies , and quality -of-life assumptions were modeled . RESULTS Per 1000 men of all ages who were followed for their entire life span , we predicted that annual screening of men between the ages of 55 and 69 years would result in nine fewer deaths from prostate cancer ( 28 % reduction ) , 14 fewer men receiving palliative therapy ( 35 % reduction ) , and a total of 73 life-years gained ( average , 8.4 years per prostate-cancer death avoided ) . The number of QALYs that were gained was 56 ( range , -21 to 97 ) , a reduction of 23 % from unadjusted life-years gained . To prevent one prostate-cancer death , 98 men would need to be screened and 5 cancers would need to be detected . Screening of all men between the ages of 55 and 74 would result in more life-years gained ( 82 ) but the same number of QALYs ( 56 ) . CONCLUSIONS The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects . Longer follow-up data from both the ERSPC and quality -of-life analyses are essential before universal recommendations regarding screening can be made . ( Funded by the Netherl and s Organization for Health Research and Development and others . ) BACKGROUND In 2008 , we reported that radical prostatectomy , as compared with watchful waiting , reduces the rate of death from prostate cancer . After an additional 3 years of follow-up , we now report estimated 15-year results . METHODS From October 1989 through February 1999 , we r and omly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy .  Follow-up was complete through December 2009 , with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death . Relative risks , with 95 % confidence intervals , were estimated with the use of a Cox proportional-hazards model . RESULTS During a median of 12.8 years , 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died ( P=0.007 ) . In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting , death was 
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In addition , the implication s of adding either the PCA3 assay or the phi to clinical assessment were not clear .
Furthermore , the addition of the PCA3 assay or the phi to clinical assessment plus magnetic resonance imaging was not found to improve discrimination .
The results from the cost-effectiveness analyses indicated that using either the PCA3 assay or the phi in the NHS was not cost-effective .
The clinical benefit of using the PCA3 assay or the phi in combination with existing tests , scans and clinical judgement has not yet been confirmed .
The results from the cost-effectiveness analyses indicate that the use of these tests in the NHS would not be cost-effective .