Authors (Year) 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) Pooled results Diagnostic Criteria 4 ng/mL 10 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL 10 ng/mL 10 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL 4 ng/mL 10 ng/mL 4 ng/mL TP (11 8 16 15 17 15 18 18 15 15 10 36 32 26 50 41 51 43 33 29 74 114 83 461 FP 4 0 63 29 47 23 53 38 53 29 25 105 56 73 61 21 126 78 77 28 106 168 64 936 10 ng/mL 309 391 TP, True Positive; FP, False Positive; FN, False Negative; TN, True Negative. Sn, Sensitivity; Sp, Specificity; PA, Percent Agreement. All bold numbers were directly calculated in this study using each formula. cancer jumped further to 68.3%. Also, if the PSA10 was normal and only the DRE or the TRUS was positive, the DR of prostate cancer was only 14 out of 313 patients (4.5%). Once two of tests were abnormal, even if the PSA10 was normal, then the DR of prostate cancer jumped to 18.8-50.0%. If all three diagnostic tests were abnormal, the DR of prostate cancer increased further to 76.8%. DISCUSSION Because the estimates of d̅were not large (not close to 3.0) in the results of quantitative meta- Yonsei Med J Vol. 46, No. 3, 2005 Jae Mann Song, et al. Table 2. Outcomes of Prostate Specific Antigen for Diagnosis of Prostate Cancer by the Study (N=13) analysis, we concluded that prostate-specific anti- gen testing, digital rectal examination and tran- srectal ultrasonography for the diagnosis of pros- tate cancer were not very effective when used separately. This estimate (d̅) is analogous to the effect-size described for the continuous-outcome measures. Thus, this value (0.8-1.1) as the estimate of d̅would suggest poor separation or discri- mination24 by each of this diagnostic triad for the detection of prostate cancer. In general, the mea- sure d̅appears to be more consistent across the studies than is either the sensitivity or specificity, but if either (normality or equal variances) of the assumptions is not met, then the effectiveness FN 4 7 2 3 2 4 2 2 0 0 1 4 8 0 4 13 2 10 3 7 16 5 36 44 91 TN 32) 36 52 86 27 51 8 23 10 34 28 56 105 63 15 55 31 79 102 151 69 59 163 524 811 Sn 73.3 53.3 88.9 83.3 89.5 78.9 90.0 90.0 100.0 100.0 90.9 90.0 80.0 100.0 92.6 75.9 96.2 81.1 91.7 80.6 82.2 95.8 69.7 91.3 77.3 Sp 88.9 100.0 45.2 74.8 36.5 68.9 13.1 37.7 15.9 54.0 52.8 34.8 65.2 46.3 19.7 72.4 19.7 50.3 57.0 84.4 39.4 26.0 71.8 35.9 67.5 PA 84.3 86.3 51.1 75.9 47.3 71.0 32.1 50.6 32.1 62.8 59.4 45.8 68.2 54.9 50.0 73.8 39.0 58.1 62.8 83.7 54.0 50.0 71.1 50.1 69.9