Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis

Prostate cancer (PCa) is the second most prevalent type of malignancy and one of the lead causes of cancer‑related mortality among the male population, accounting for almost 48% of all incident cases in men. The present study aimed to evaluate the specificity and sensitivity of blood and urine biopsies as tools for diagnosing prostate cancer in a systematic review and meta‑analysis. A comprehensive search and selection of studies (written in the English language and published between 2013 and 2025) on the use of liquid biopsy in the diagnosis of PCa was conducted from four electronic databases: PubMed, Cochrane Library, OVID Medline and Science Direct. Following the search, three studies on blood‑based biopsies and nine studies on urine‑based biopsies were included in the present meta‑analysis after screening and excluding 1,876 studies. For blood biopsy, the pooled sensitivity was 0.40 [95% confidence interval (CI), 0.25‑0.57], with a high heterogeneity (I²=96.5%). The pooled specificity for blood biopsy was 0.98 (95% CI, 0.93‑0.99), also exhibiting significant heterogeneity with I²=94.6%. The pooled sensitivity for urine biopsy was 0.83 (95% CI, 0.77‑0.88) with a heterogeneity of I²=91.8%. The pooled specificity for urine biopsy was 0.62 (95% CI, 0.42‑0.79) with I²=98.9%. The random effects model demonstrated a pooled specificity of 0.87 (95% CI, 0.74‑0.94). On the whole, the present study demonstrates that blood biopsy has potential for use as a tool for confirming diagnoses (rule‑in), although this biopsy may have a low to moderate sensitivity. By contrast, urine biopsy provides a significant advantage with a higher and more reliable sensitivity, although with greater variability in specificity.