Evidence map›Paper›PMID 35125113›Full record

SynthesisBMC medicine2022

Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients.

Samuel W D Merriel, Lucy Pocock, Emma Gilbert, Sam Creavin, Fiona M Walter, Anne Spencer, Willie Hamilton

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 115 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
115citing papers in PubMed, 6 pooled it
27.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

115 citing papers in PubMed, 6 syntheses or guidelines pooled it, 186 citations in OpenAlex.

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55 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Samuel W D MerrielUniversity of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK. s.w.d.merriel@exeter.ac.uk.ORCID 0000-0003-2919-9087
Lucy PocockUniversity of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
Emma GilbertUniversity of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
Sam CreavinUniversity of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
Fiona M WalterUniversity of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
Anne SpencerUniversity of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
Willie HamiltonUniversity of Exeter, 1.18 College House, St Luke's Campus, Exeter, Devon, UK.
University of Exeter · GB

Funding

Cancer Research UK C8640/A23385
6 · The paper itself

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.

resultsFive hundred sixty-three search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. Nineteen studies met the inclusion criteria, 18 of which were conducted in secondary care settings with 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 hierarchical summary receiver 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 in symptomatic patients. 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.

Indexed as

Prostate-Specific AntigenProstatic NeoplasmsBiasCohort StudiesHumansMaleMass ScreeningSensitivity and SpecificityProstate-Specific AntigenDiagnostic accuracyLower urinary tract symptomsLUTSPrimary careProstate cancerProstate-specific antigenPSASecondary care

Identifiers

PMID35125113
PMCPMC8819971
OpenAlexW4210440569

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.