Abstract:
OBJECTIVE : This review aimed to systematically quantify the
association between pre-operative total prostate-specific
antigen (tPSA) and survivorship of prostate cancer (PCa).
METHODS : Data sources for the review included MEDLINE,
PubMed, Cochrane Library, CINAHL, Academic Search
Complete, PsycINFO, and relevant reference lists. Databases
were searched from inception to June 2022. The study took
place between May 2022 and March 2023. We included
studies that applied a quantitative approach to examine the
interaction between pre-operative PSA and survivorship of
PCa. Pre-operative PSA constituted the independent variable,
whereas survivorship of PCa as measured by biochemical
recurrence and mortality constitute the outcome
variable. A risk of bias assessment was conducted with the
aid of a mixed-method appraisal tool. We employed metaanalysis
to quantify the association of pre-operative PSA
with biochemical recurrence and mortality and computed I2
to assess the degree of heterogeneity. RESULTS : We found a
positive weak association between pre-operative PSA and
biochemical recurrence (hazard ratio [HR] = 1.074; 95% CI = 1.042–1.106). With a median rise in PSA (≥2 ng/mL), the
likelihood for biochemical recurrence increase by approximately
7.4%. There was statistically a significant association
between PSA and mortality (HR = 1.222, CI = 0.917–1.630).
CONCLUSIONS : Biochemical recurrence associates with preoperative
PSA in an inconsistent manner. The sole use of preoperative
PSA in estimating post-prostatectomy biochemical
recurrence should be discouraged. There is need for a
multifactorial model which employs a prudent combination
of the most important and cost-effective biomarkers in
predicting post-prostatectomy biochemical recurrence.
