AHRQ reviews evidence on multigene panels for prostate cancer risk assessmentEvidence is currently insufficient to conclude whether single nucleotide polymorphism-based (SNP) panels perform adequately as screening or risk-stratification tools to genetically assess whether a man is at increased risk for prostate cancer, concludes a new review. The evidence review was conducted by the McMaster University Evidence-based Practice Center in Hamilton, Ontario, Canada, with support from the Agency for Healthcare Research and Quality (AHRQ). The review was conducted to address questions about the accuracy of prostate-specific antigen screening (PSA) in asymptomatic men, the difficulty of determining prognosis in many affected men, and the lack of clarity on the utility of different therapeutic approaches.
Given the issues with PSA testing, SNP panels were seen as possible substitutes for or as a supplement to PSA screening. Prostate cancer, one of the most common types of cancer, led to more than 36,000 deaths among men in North America in 2010.
For the executive summary and full evidence report, Multigene Panels in Prostate Cancer Risk Assessment, go to http://www.ahrq.gov/clinic/tp/mgenprcatp.htm.
Full Title: Multigene Panels in Prostate Cancer Risk AssessmentJuly 2012
This report addresses the evidence on the validity and utility of using single nucleotide polymorphism (SNP) panels in the detection, diagnosis, and clinical management of prostate cancer.
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Structured AbstractObjectives: The aim of this review is to identify, synthesize, and appraise the literature on the analytic validity, clinical validity, and clinical utility of commercially available SNP panel tests for assessing the risk of prostate cancer.
Data Sources: MEDLINE®, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and Embase, from the beginning of each database to October 2011. Search strategies used combinations of controlled vocabulary (medical subject headings, keywords) and text words. Grey literature was identified.
Review Methods: Three Key Questions (KQs) encompassing broad aspects of the analytic validity, clinical validity, and clinical utility of SNP-based panels were developed with the input of a Technical Expert Panel assembled by the Evidence-based Practice Center and approved by the Agency for Healthcare Research and Quality. Standard systematic review methodology was applied, with eligibility criteria developed separately for each KQ.
Results: From 1,998 unique citations, 14 were retained for data abstraction and quality assessment following title and abstract screening and full text screening. All focused on clinical validity (KQ2), and evaluated 15 individual panels with two to 35 SNPs. All had poor discriminative ability for predicting risk of prostate cancer and/or distinguishing between aggressive and asymptomatic/latent disease. The risk of bias of the studies was determined to be moderate. None of the panels had been evaluated in routine clinical settings.
Conclusions: The evidence on currently available SNP panels does not permit meaningful assessment of analytic validity. The limited evidence on clinical validity is insufficient to conclude that the panels assessed would perform adequately as screening or risk stratification tests. No evidence is available on the clinical utility of current panels.
Download ReportMultigene Panels in Prostate Cancer Risk Assessment.
Current as of July 2012
Multigene Panels in Prostate Cancer Risk Assessment. Structured Abstract, July 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/mgenprcatp.htm