Meta-analysis of PSA, DRE and TRUS Table 1. General Characteristics of Studies for the Diagnosis of Prostate Cancer in this Meta-Analysis (N=13) NRoe.f.of Authors (Year) Specialty of author(s) 26 27 28 29 30 31 32 33 34 35 36 37 38 Kang SG (1991) Kim TH et al. (1994) Park HK et al. (1994) Byun HS (1995) Park SW et al. (1995) Choi JH et al. (1996) Seo WK et al. (1996) Kim JH et al. (1998) Jung JY et al. (1998) Yoon JH et al. (1998) Chang HJ et al. (1999) Kim JH et al. (2000) Jung BC et al. (2002) Total U U U U U U U U U DR+U U U+P U Sample size 51 133 93 81 78 64 201 162 130 210 215 TRUS:133 265 346 2,029 Diagnosis by pathological results Age (years) Cancer BPH 15 (29.4) 36 (70.6) 18 (13.5) 110 (82.7) 19 (20.4) 68 (73.1) 20 (24.7) 61 (75.3) 15 (19.2) 60 (76.9) 11 (17.2) 53 (82.8) 40 (19.9) 155 (77.1) 26 (16.0) 136 (84.0) 54 (41.5) 76 (58.5) 53 (25.2) 157 (74.8) 36 (16.7) 179 (83.3)§ 35 (26.3) 98 (73.7)§ 90 (33.9) 169 (63.8) 119 (34.4) 219 (63.3) Others* - 5 (3.8) 6 (6.5) - 3 (3.9) - 6 (3.0) - - - - - 6 (2.3) 8 (2.3) 516 (25.4) 1,479 (72.9) 34 (1.7) Mean - 67.9 70.1 69.8 70.3 68.0 71.0 62.7 66.0 67.0 69.2 - 68.6 66.0 67.8 Range >50 50-85 50-89 52-87 47-87 40-90 51-87 50-84 42-86 41-96 54-89 - 47-89 30-93 30-93 No. of Ref., Number of Reference; U, Urologist; DR, Diagnostic Radiologist; P, Pathologist. BPH, Benign Prostate Hyperplasia; TRUS, Transrectal Ultrasonography. *Others include inflammation (chronic prostatitis), tuberculosis, infarct etc. All patients took prostatectomy. 82 patients were diagnosed by transurethral prostatectomy. §The number of patients was recalculated by the data according to the evidence of its study. 71.5% (55.9% to 90.4%), and 70.7% (57.8% to 90.2%), respectively. Also, the overall sensitivity, specifi- city and percent agreement (range) for TRUS were 73.6% (60.0% to 93.3%), 61.3% (26.5% to 91.7%), and 64.6% (37.0% to 92.2%), respectively. In order to check the possibility that the dif- ferences in the study results may have occurred by chance, a homogeneity test was performed on the all diagnostic tests (Table 5). According to the outcomes of the homogeneity tests for both PSA criteria (PSA4 and PSA10), these studies were homogeneous (Q=16.11, p-value>0.05; Q=13.43, p-value>0.05), so we used the results in a fixed effect model. Because both the DRE and TRUS tests proved to be significant and heterogeneous (Q=50.12, p-value<0.001; Q=49.70, p-value < 0.001), a fixed effect model was rejected and we then used the results in a random effect model. In a quantitative meta-analysis using the Has- selblad method, the estimate of d̅ for PSA4, PSA10, DRE and TRUS were 0.8517 [95% confi- dence interval (CI): 0.6694, 1.0340], 1.0996 (95% CI: 0.9459, 1.2534), 0.8398 (95% CI: 0.7169, 0.9627), and 0.8002 (95% CI: 0.6714, 0.9289), respectively. Among these diagnostic tools, the estimate of d̅ for PSA10 was the largest. Also, the estimate of d̅for PSA (PSA4 and PSA10) was larger than that for DRE and TRUS. However, this diagnostic triad of prostate cancer is judged by the authors of this study to be noneffective. Among the 13 studies, the results of patients tested by this diagnostic triad were done in only 6 studies.27,28,30-32,36 The outcomes of combination testing with PSA, DRE, and TRUS for detecting prostate cancer are shown in Table 6-1 and Table 6-2. If the PSA4 was negative and only the DRE or the TRUS was positive, the detection rate (DR) of prostate cancer was only 6 out of 150 patients (4.0%). Once two tests were positive, even if the PSA4 was negative, the DR of prostate cancer increased from 16.8% to 34.3%. If all results of this diagnostic triad were positive, the DR of prostate Yonsei Med J Vol. 46, No. 3, 2005