All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain. The area under the hierarchical summary receiver operator characteristic curve was 0.72 (95% CI 0.68, 0.76). Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33).
All studies used histology obtained by transrectal ultrasound-guided biopsy (TRUS) as a reference test usually only for patients with elevated PSA or abnormal prostate examination. Nineteen studies met the inclusion criteria, 18 of which were conducted in secondary care settings with one from a screening study cohort. Resultsįive hundred sixty-three search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression.
Study quality was assessed using the QUADAS-2 tool by two investigators independently. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included.
MethodsĪ systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood. Prostate-specific antigen (PSA) is a commonly used test to detect prostate cancer.
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