Presentation Authors: Bashar Matti*, Weisi Xia, Kamran Zargar-Shoshtari, Auckland, New Zealand
Introduction: Prostate Specific Antigen (PSA) is the most commonly utilised serum marker for Prostate cancer (Pca) screening and monitoring. However, the validity of PSA as a screening tool is still controversial. In order to improve the predictive accuracy of PSA for Pca detection, the concept of age adjusted reference values have been proposed. This review aims to compare and combine the age specific reference values for PSA amongst the different international populations.
Methods: In concordance with the PRISMA statement, a systematic review of published English articles using Medline, Embase and Cochrane databases, from inception to June 2018 was conducted. Additional studies were identified from reference screening of relevant articles. Studies that reported the reference value for PSA, defined as upper limit of the 95th percentile, in healthy men aged 40 â€“ 79, were included. Two independent authors identified the eligible articles and extracted the data using predefined fields. Risk of bias was assessed with a modified version of the Agency for Healthcare Research and Quality methodological checklist for cross-sectional studies.
Results: 45 studies were included in the final qualitative analysis, of which 40 studies were included in the meta-analysis. Weighted analysis revealed that PSA reference values significantly increased with age (Pearson correlation score = 0.81, p < 0.001). Pooled age adjusted reference values for PSA were 2.06, 2.97, 4.65 and 6.46 ng/ml for men aged in the 40s, 50s, 60s and 70s respectively. The studies were of average quality with low to moderate bias. Significant differences in PSA reference values observed between the cohorts. This was attributed to heterogeneity in the populations and PSA measurement assays.
Conclusions: This is the first systematic review and meta-analysis of PSA reference values. PSA increased with age and significant variability existed in PSA among the different populations.
Source of Funding: The University of AucklandThe Goodfellow foundation for Urology Research