Cell-free DNA as a Promising Diagnostic Biomarker in Prostate Cancer: A Systematic Review and Meta-Analysis.

Objective: The detection of cell-free DNA (cfDNA) as a part of "liquid biopsy" of prostate cancer (PCa) has been widely explored. However, its diagnostic value for PCa remains controversial. Based on the data from the latest literature published in the past decade, the present review was conducted to clarify the diagnostic value of cfDNA in PCa. Methods: The related studies were systematically searched in the databases of PubMed, Embase, Web of Science, and Cochrane Library from January 1, 2010 to December 1, 2020. Sensitivity (SEN), specificity (SPE), and other relative parameters were pooled using a random model. Results: 14 eligible studies with 1049 PCa patients and 973 controls were selected based on the inclusion and exclusion criteria. Results demonstrated that cfDNA showed favorable SPE (0.89, 95% CI: 0.79, 0.94) but unsatisfied SEN (0.56, 95% CI: 0.43, 0.68) in the PCa diagnosis. The positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratios (DOR) were 5.1 (95% CI: 3.1, 8.5), 0.49 (95% CI: 0.39, 0.63), and 10 (95% CI: 6, 17), respectively. The summary receiver operating characteristic graph (SROC) with an area under the curve (AUC) of 0.80 (95% CI: 0.76, 0.83) was constructed which indicated favorable diagnostic accuracy for PCa. Results of the subgroup analysis and metaregression analysis reminded "ethnicity" and "methylation" might be sources of heterogeneity. The potential publication bias was not found using Deek's funnel plot asymmetry test ( Conclusions: Our meta-analysis illustrated that the cfDNA could undertake a promising role in the PCa diagnosis.