Alpha-methylacyl-CoA racemase demonstrated a pooled sensitivity and specificity of 90 percent and 91 percent, respectively, for diagnosing prostate cancer in biopsy samples using immunohistochemistry, according to a recent meta-analysis.
A systematic review and meta-analysis published in the Journal of Pathology and Translational Medicine assessed the diagnostic performance of alpha-methylacyl-CoA racemase (AMACR) for detecting prostate cancer using immunohistochemistry (IHC) on biopsy specimens. The review included 37 studies involving 5,898 samples. Of these, 27 studies used IHC to evaluate biopsy specimens and reported pooled sensitivity and specificity values of 90 percent and 91 percent, respectively.
Studies using reverse transcription–polymerase chain reaction (RT-PCR) on biopsy samples reported slightly lower pooled sensitivity (83 percent) and similar specificity (91 percent). Fewer studies assessed AMACR expression in urine, serum, or semen samples, and these showed lower diagnostic accuracy. For urine-based RT-PCR, sensitivity was 72 percent and specificity was 69 percent; for serum-based RT-PCR, sensitivity was 70 percent and specificity was 39 percent.
In analyses of AMACR-positive high-grade prostatic intraepithelial neoplasia or atypical lesions, more than half of cases progressed to prostate cancer. AMACR-negative lesions were less likely to be associated with subsequent malignancy. These data were drawn from seven studies that tracked the progression of such lesions.
Geographic subgroup analyses showed variation in diagnostic performance. The pooled area under the curve was 0.98 in studies conducted in Asia, 0.95 in North America, and 0.85 in Europe. Differences in study size, population demographics, and diagnostic methodologies contributed to observed heterogeneity.
Most studies applied IHC for AMACR in combination with basal cell markers, such as p63 or high-molecular-weight cytokeratin, following recommendations from the International Society of Urologic Pathology. While AMACR is generally absent in benign glands, a small proportion of benign tissues may show AMACR expression, which may affect specificity.
This meta-analysis included studies with diverse sample types and methodologies. While most evidence was derived from biopsy-based IHC studies, further investigations using non-invasive specimens and standardized protocols may clarify the broader diagnostic role of AMACR in prostate cancer detection.
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