The Comprehensive Systematic Review of Association of PSA Level to Clinical Stage of Carcinoma Prostat

Introduction: Prostate-specific antigen (PSA) is a cornerstone biomarker in prostate cancer (PCa) management, used for screening, diagnosis, staging, and monitoring treatment response. However, the precise relationship between PSA levels and clinical stage is complex and influenced by numerous factors. This systematic review synthesizes the current evidence to elucidate the association between PSA and the clinical stage of prostate carcinoma. Methods: A comprehensive systematic review was conducted. We screened studies based on predefined criteria, including the involvement of prostate cancer patients, measurement of serum PSA levels, availability of clinical staging information, and analysis of the PSA-stage relationship. Studies were limited to human clinical studies with adequate sample sizes (≥10 patients) that examined pre-treatment PSA. Data were extracted on study design, patient characteristics, PSA measurement details, staging systems, statistical analyses, primary findings, outcomes, confounding variables, and study quality from 80 included sources. Results: The evidence demonstrates a significant but nuanced association between PSA levels and clinical stage. Established PSA thresholds correlate with disease severity: levels 20 ng/mL consistently predict advanced/high-risk or metastatic disease (Buzzoni et al., 2015; Tombal et al., 2010). However, paradoxical findings exist, such as worse survival in high-grade patients with very low PSA (