Background Prostate-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. Methods A 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. Results Five 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. Conclusions Currently 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.

No 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.

Background: Retrospective study to compare the classification, as normal, hypoplastic or aplastic, of thoracic (T10-T13) caudal articular process (CAP) morphology in Pug dogs with a thoracolumbar myelopathy as normal, hypoplastic or aplastic, between T2 weighted Turbo Spin Echo (T2W-TSE) and Volumetric Interpolated Breath-hold Examination (VIBE) Magnetic Resonance Imaging (MRI) sequences, in comparison to Computed Tomography (CT). We hypothesised a stronger agreement for VIBE in comparison to T2W-TSE. Results: Diagnostic accuracy of T2W-TSE was inferior to VIBE for aplastic (60%, 95% CI 0.561 – 0.639) versus 78%, 95%CI 0.744 - 0.815) hypoplastic (44%, 95%CI 0.427 – 0.452 versus 62.5%, 95%CI 0.595 - 0.655) and normal CAP (70%, 95%CI 0.655 – 0.744 versus 87% 95%CI 0.848- 0.892). Superior accuracy of classification using VIBE versus T2W-TSE sequences using the McNemar Chi squared test was significant for aplastic (p= 0.0002) and normal CAP (p=0.004). VIBE sequences had a sensitivity of 96% and specificity of 75% and with T2W-TSE imaging sensitivity 81% and specificity of 75%. Conclusion: Three-dimensionally reconstructable VIBE sequences were significantly more accurate than traditional T2W-TSE MRI sequences in classifying CAP morphology, which should reduce the need for CT for pre-operative assessment.

No abstract