Prostate-Specific Antigen (PSA) Testing in Prostate Cancer Detection: A Systematic Review of Sensitivity, Specificity, and False Positive Influences
DOI:
https://doi.org/10.37506/ygwk4b44Keywords:
prostate cancer, PSA testing, diagnostic accuracy, sensitivity, PSA density, specificity, BPH, overdiagnosis, biomarker, prostate biopsy, cancerAbstract
Background: Prostate-Specific Antigen (PSA) testing is a cornerstone in early prostate cancer detection. Despite its high sensitivity, low specificity remains a major clinical concern, often causing overdiagnosis and overtreatment of indolent tumors.
Objective: This systematic review evaluates the diagnostic accuracy of PSA testing, focusing on sensitivity and specificity, and investigates the biological, clinical, and methodological factors underlying its low specificity.
Methods: A comprehensive literature search was conducted through PubMed, Nature, and ScienceDirect for studies published between 2015 and 2025. From 26 screened articles, 12 met inclusion criteria, with six studies addressing diagnostic accuracy and six exploring causes of low specificity. All studies confirmed prostate cancer diagnosis via histopathological biopsy.
Results: PSA testing showed consistently high sensitivity (88.9%–94.5%) but low specificity (14.1%–26.6%) across most populations, except a Nigerian cohort reporting 60% specificity. Key factors contributing to low specificity included benign prostatic hyperplasia (BPH), prostatitis, physiological influences (e.g., ejaculation, infections), lack of cancer-specific PSA isoform detection, and uniform PSA thresholds that overlook individual variability (Kobayashi, 2023). Use of PSA density (PSAD) and population-specific adjustments improved specificity.
Conclusion: While PSA testing effectively detects prostate cancer, its low specificity limits its diagnostic value as a standalone test. Incorporating adjunct tools such as PSAD, age-adjusted cutoffs, and advanced imaging can enhance accuracy and reduce unnecessary interventions. Future research should focus on refining PSA-based models and identifying molecular biomarkers to better distinguish aggressive cancers from benign or indolent conditions.
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Copyright (c) 2025 Sharon Rose Kombathula, Vijjapu Devi Deepak, Rayeesa Chappantakath, Jainil Sejpal, Boykhurozov Jasurbek, Boykhurozov Azamat, Gundlapally Sai Priya, Devayan Shukla, Kalash Dwivedi, Chikkegowda Deekshith
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