scholarly journals Systematic Review & Meta-Analysis of the Diagnostic Accuracy of Prostate Specific Antigen (PSA) for the Detection of Prostate Cancer in Symptomatic Patients

2021 ◽  
Author(s):  
Samuel William David Merriel ◽  
Lucy Pocock ◽  
Emma Gilbert ◽  
Sam Creavin ◽  
Fiona M Walter ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Prostate Specific Antigen ◽  
Meta Analysis ◽  
Specific Antigen ◽  
Database Search ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Reference Test ◽  
Psa Testing

Abstract BackgroundProstate Specific Antigen (PSA) is a commonly used test to detect prostate cancer. 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.MethodsA systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. 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. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression.Results563 search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. 19 studies met the inclusion criteria, 18 of which were conducted in secondary care settings (one from a screening study cohort). 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. 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). The area under the receiving-operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain.ConclusionsCurrently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.

scholarly journals Do antibiotics decrease prostate-specific antigen levels and reduce the need for prostate biopsy in type IV prostatitis? A systematic literature review

2017 ◽  
Vol 12 (1) ◽  
pp. E25-30 ◽  
Author(s):  
Karel T. Buddingh ◽  
Marlies G.F. Maatje ◽  
Hein Putter ◽  
René F. Kropman ◽  
Rob C.M. Pelger
Keyword(s):  
Prostate Cancer ◽  
Antibiotic Therapy ◽  
Prostate Specific Antigen ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Specific Antigen ◽  
Inclusion Criteria ◽  
Prostate Biopsies ◽  
Type Iv ◽  
Significant Difference

Introduction: Inflammation of the prostate can be a cause of elevated prostate-specific antigen (PSA) in men referred for suspected prostate cancer. This systematic review assesses the evidence for antibiotic therapy in patients with type IV (asymptomatic) prostatitis with regard to reduction of PSA levels and discrimination between prostate cancer and inflammation.Methods: MEDLINE, EMBASE, and the Cochrane registry were searched for papers reporting on cohorts of men with elevated PSA and type IV prostatitis that were treated with antibiotics.Results: The search yielded 160 papers, of which 11 met the inclusion criteria: two randomized trials and nine cohort studies. In total, the studies reported on 1011 patients with type IV prostatitis, of whom 926 were treated with antibiotics. PSA normalization was seen after antibiotic treatment in 33.2% of patients (95% confidence interval [CI] 24.9‒42.8). Meta-analysis of the randomized trials did not demonstrate a higher likelihood of PSA normalization in the antibiotics arm as compared to the control arm (odds ratio [OR] 1.27; 95% CI 0.58–2.76; p=0.553). Four studies performed prostate biopsies in all patients. Although three of these studies demonstrated lower prevalence of prostate cancer in patients in whom PSA had normalized, meta-analysis failed to show a statistically significant difference (OR 0.39; 95% CI 0.06–2.49; p=0.319).Conclusions: The available evidence does not support antibiotic therapy for differentiation between benign and malignant cause of elevated PSA in men with type IV prostatitis.

Trends in Prostate Specific Antigen (PSA) testing and prostate cancer incidence and mortality in Australia: A critical analysis

2022 ◽  
Vol 77 ◽  
pp. 102093
Author(s):  
Thanya Pathirana ◽  
Rehan Sequeira ◽  
Chris Del Mar ◽  
James A. Dickinson ◽  
Bruce K. Armstrong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Cancer Incidence ◽  
Critical Analysis ◽  
Specific Antigen ◽  
Prostate Cancer Incidence ◽  
Psa Testing ◽  
Incidence And Mortality

scholarly journals Relationship of Prostate Specific Antigen and Digital Rectal Examination in the Prediction of Prostate Cancer

2020 ◽  
Vol 16 (2) ◽  
pp. 83-87
Author(s):  
Bhusan Raj Timilsina ◽  
Gaurav Devkota ◽  
Shweta Giri ◽  
Sulav Pradhan ◽  
Sudeep RaJ KC
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Cross Sectional Study ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Rectal Examination ◽  
Relationship Of

Background: Prostate cancer is one of the most common and leading cause of death among different genitourinary causes. However, screening of prostate cancer is limited to Digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) in Nepal. The aim of this study is to find out which modality is more helpful for the diagnosis of Prostate Cancer. Methods: A retrospective cross-sectional study was conducted in the department of Urology, College of Medical Sciences, Chitwan, Nepal. All patients included in this study were who presented to the OPD with Lower Urinary Tract Symptoms (LUTS). The patients were above the age of 40 with clinical suspicion prostate cancer based on either DRE or PSA.   Results: A total of 150 patients were enrolled from April 2019 to April 2020. Their mean± SD age was of 65.18±9.38 years. The accuracy of the diagnostic test for DRE and PSA were cut off at 4, PSA cut off range of 4 to 10, PSA cut off range of 10 to 30 and PSA cut off at 30 showed that all the screening indices were better for DRE (Sensitivity=100%, Specificity=59.2%, Diagnostic Accuracy=62.2%) than for PSA cut off at 4 (Sensitivity=100%, Specificity=27.6%, Diagnostic Accuracy=32.9%). Among various cut off score or ranges for PSA, cut off score at 30 provided the best screening indices with Sensitivity of 66.7%, Specificity of 97.4% and Diagnostic Accuracy of 95.1%. Conclusions: PSA has higher diagnostic accuracy then DRE. Keywords: DRE; LUTS; Prostate cancer; PSA.  

scholarly journals The Proportion of Prostate-specific Antigen (PSA) Complexed to α1-Antichymotrypsin Improves the Discrimination between Prostate Cancer and Benign Prostatic Hyperplasia in Men with a Total PSA of 10 to 30 μg/L

2002 ◽  
Vol 48 (8) ◽  
pp. 1251-1256 ◽  
Author(s):  
Manuel Martínez ◽  
Francisco España ◽  
Montserrat Royo ◽  
José M Alapont ◽  
Silvia Navarro ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Benign Prostatic Hyperplasia ◽  
Confidence Interval ◽  
Diagnostic Accuracy ◽  
Prostate Specific Antigen ◽  
Correct Diagnosis ◽  
Specific Antigen ◽  
Prostatic Hyperplasia ◽  
Total Psa ◽  
L 14

Abstract Background: The aim of this study was to assess the diagnostic accuracy of the proportion of prostate-specific antigen (PSA) complexed to α1-antichymotrypsin (PSA-α1ACT:PSA ratio) in the differential diagnosis of prostate cancer (CaP) and benign prostatic hyperplasia (BPH) in men with total PSA of 10–30 μg/L. Methods: We used our immunoassays (ELISAs) for total PSA and PSA-α1ACT complex to study 146 men. In 123, total PSA was between 10 and 20 μg/L; 66 of these had CaP and 57 BPH. In 23 men, total PSA was between 20 and 30 μg/L; 14 of these had CaP and 9 BPH. We calculated the area under the ROC curves (AUC) for total PSA, PSA-α1ACT complex, and PSA-α1ACT:PSA ratio, and determined the cutoff points that gave sensitivities approaching 100%. Results: In the total PSA range between 10 and 20 μg/L, the AUC was significantly higher for the PSA-α1ACT:PSA ratio (0.850) than for total PSA (0.507) and PSA-α1ACT complex (0.710; P <0.0001). A cutoff ratio of 0.62 would have permitted diagnosis of all 66 patients with CaP (100% sensitivity) and avoided 19% of unnecessary biopsies (11 of 57 patients). In the total PSA range between 20 and 30 μg/L, the AUC for the PSA-α1ACT:PSA ratio (0.980; 95% confidence interval, 0.82–0.99) was greater than the AUC for total PSA (0.750; 95% confidence interval, 0.51–0.89; P = 0.042). In this range, a cutoff point of 0.64 would have permitted the correct diagnosis of all 14 patients with CaP and 6 of the 9 with BPH. Conclusions: The diagnostic accuracy of the PSA-α1ACT:PSA ratio persists at high total PSA concentrations, increasing the specificity of total PSA. Prospective studies with large numbers of patients are needed to assess whether the ratio of PSA-α1ACT to total PSA is a useful tool to avoid unnecessary prostatic biopsy in patients with a total PSA >10 μg/L.

scholarly journals Accuracy of multiparametric magnetic resonance imaging for detecting extracapsular extension in prostate cancer: a systematic review and meta-analysis

2019 ◽  
Vol 92 (1104) ◽  
pp. 20190480 ◽  
Author(s):  
Fan Zhang ◽  
Chen-Lu Liu ◽  
Qian Chen ◽  
Sheng-Chao Shao ◽  
Shuang-Qing Chen
Keyword(s):  
Prostate Cancer ◽  
Confidence Interval ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
High Specificity ◽  
Cochrane Library ◽  
Extracapsular Extension ◽  
Predictive Values ◽  
Enhanced Mri

Objective: To evaluate the diagnostic accuracy of multiparametric MRI (mpMRI) for detecting extracapsular extension (ECE) in patients with prostate cancer (PCa). Methods and materials: We searched MEDLINE, PubMed, Embase and the Cochrane library up to December 2018. We included studies that used mpMRI to differentiate ECE from organ-confined PCa with a combination of T2 weighted imaging (T2WI), diffusion-weighted imaging, and dynamic contrast-enhanced MRI. All studies included had pathological diagnosis with radical prostatectomy. Two reviewers independently assessed the methodological quality of included studies by using Quality Assessment of Diagnostic Accuracy Studies 2 tool. We calculated pooled sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios and receiver operating characteristic curve for mpMRI from 2 × 2 tables. Results: A total of 17 studies that comprised 3374 participants were included. The pooled data showed a sensitivity of 0.55 (95% confidence interval 0.43, 0.66]) and specificity of 0.87 (95% confidence interval 0.82, 0.91) for extracapsular extension detection in PCa. Conclusion: First, our meta-analysis shows moderate sensitivity and high specificity for mpMRI to differentiate ECE from organ-confined prostate cancer before surgery. Second, our meta-analysis shows that mpMRI had no significant differences in performance compared with the former meta-analysis with use of T2WI alone or with additional functional MRI. Advances in knowledge: It is the first meta-analysis to evaluate the accuracy of mpMRI in combination of TWI, diffusion-weightedimaging and dynamiccontrast-enhanced-MRI for extracapsular extension detection.

scholarly journals PSA screening for prostate cancer

2017 ◽  
Vol 63 (8) ◽  
pp. 722-725 ◽  
Author(s):  
Marcus V. Sadi
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Early Diagnosis ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Low Grade ◽  
Psa Screening ◽  
Psa Testing ◽  
Baseline Values

Summary Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient’s quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

The role of prostate specific antigen measurement in the detection and management of prostate cancer.

2000 ◽  
pp. 37-51 ◽  
Author(s):  
A F Nash ◽  
I Melezinek
Keyword(s):  
Prostate Cancer ◽  
Endocrine Therapy ◽  
Prostate Specific Antigen ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Marked Change ◽  
Reference Ranges ◽  
Psa Density ◽  
Psa Testing

The introduction of prostate specific antigen (PSA) testing has revolutionised the early detection, management and follow-up of patients with prostate cancer and it is considered to be one of the best biomedical markers currently available in the field of oncology. Its use with annual digital rectal examination in prostate cancer screening programmes has led to a marked change in the distribution of stage at presentation towards earlier disease and led to a significant increase in the detection of potentially curable disease. In order to improve the specificity of PSA testing and thereby reduce the number of unnecessary prostatic biopsies, a number of refinements of PSA evaluation have been proposed. These include free to total PSA ratio, PSA density, PSA density, PSA density of the transition zone, PSA velocity and age-specific PSA reference ranges. The utility of these approaches is considered in this review. The role of PSA monitoring in the detection of recurrence following radical prostatectomy and radiotherapy is discussed, as well as its role in monitoring patients treated with endocrine therapy is discussed, as well as its role in monitoring patients treated with endocrine therapy in terms of correlating PSA response with outcome, in detecting disease progression and in guiding the use of subsequent therapies. Large continuing multicentre screening and outcome studies will provide important information enabling greater refinement of the use of this important diagnostic and monitoring tool in the future detection and management of prostate cancer.

scholarly journals Efficacy and Safety of Abiraterone Acetate and Enzalutamide for the Treatment of Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
ZhenHeng Wei ◽  
ChuXin Chen ◽  
BoWen Li ◽  
YongYue Li ◽  
Hong Gu
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Prostate Specific Antigen ◽  
Meta Analysis ◽  
Specific Antigen ◽  
Abiraterone Acetate ◽  
Efficacy And Safety ◽  
Castration Resistant Prostate Cancer ◽  
Randomized Controlled ◽  
Castration Resistant

ObjectiveThe androgen receptor-targeting drugs abiraterone acetate and enzalutamide have shown positive results as treatments for metastatic castration-resistant prostate cancer (mCRPC). Therefore, a meta-analysis was conducted to compare the efficacy and safety of abiraterone acetate and enzalutamide in patients with mCRPC.MethodsWe retrieved relevant articles from PubMed, Cochrane, and EMBASE published before December 31, 2020. Eleven articles were initially selected, and four phase III, double-blind, randomized controlled trials of abiraterone acetate and enzalutamide that involved 5199 patients with mCRPC were included. The end points were time to prostate-specific antigen progression (TTPP), according to the prostate-specific antigen working group criteria; overall survival (OS); and radiographic progression-free survival (rPFS).ResultsFour randomized, controlled clinical trials involving 5199 patients were included in this study. The results of the meta-analysis showed that compared with placebo alone, abiraterone significantly improved OS (HR=0.69, 95% CI: 0.60-0.8, P<0.00001), rPFS (HR=0.64, 95% CI: 0.57-0.71, P < 0.00001), and TTPP (HR=0.52, 95% CI: 0.45-0.59, P < 0.00001) in patients with mCRPC. Compared with placebo, enzalutamide significantly improved OS (HR=0.67, 95% CI: 0.59-0.75, P<0.00001), rPFS (HR=0.33, 95% CI: 0.29-0.37, P< 0.00001), and TTPP (HR=0.19, 95% CI: 0.17-0.22, P < 0.00001). An indirect comparison was performed to compare the efficacy of abiraterone and enzalutamide. The results showed that there was no significant difference between abiraterone and enzalutamide with regard to improving the OS of patients with mCRPC (HR=1.03, 95% CI: 0.854-1.242). Enzalutamide was superior to abiraterone with regard to improving rPFS in patients with mCRPC (HR=0.516, 95% CI: 0.438-0.608). With regard to improving TTPP, the efficacy of enzalutamide was better than that of abiraterone (HR=0.365, 95% CI: 0.303-0.441). In sAE, there was no difference between abiraterone and enzalutamide (P=0.21, I2 = 38%).ConclusionsCompared with placebo, both abiraterone and enzalutamide significantly prolonged OS, rPFS, and TTPP in patients with mCRPC. There was no difference in safety between abiraterone and enzalutamide. In addition, enzalutamide had better efficacy than abiraterone with regard to improving rPFS and TTPP but not OS, but the level of evidence was low. Therefore, a large direct comparison trial is needed to compare the efficacy of the two drugs.Systematic Review RegistrationPROSPERO, identifier (CRD42021226808)

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