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Article Open Access

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

  • Authors:
    • Fradelino Esau Selanno
    • Fakhri Rahman
    • Chaidir Arif Mochtar
    • Agus Rizal Ardy Hariandy Hamid
  • View Affiliations / Copyright

    Affiliations: Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta 10430, Indonesia
    Copyright: © Selanno et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 28
    |
    Published online on: February 19, 2026
       https://doi.org/10.3892/wasj.2026.443
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Abstract

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.
View Figures

Figure 1

PRISMA flowchart of the studies
included in the present systematic review and meta-analysis.

Figure 2

Summary of QUADAS-2 for assessing the
risk of bias of the included studies. The studies included were the
following: Constancio et al (13), Haldrup et al (14), Ried et al (15), Davey et al (24), Kim et al (16), McKiernan et al (17), Van Neste et al (18), Ochiai et al (19), Wang et al (20), Yu et al (21), Opoku Mensah et al (22) and Cheng et al (23).

Figure 3

Forest plot of the sensitivity of the
blood biopsy studies. The studies included were the following:
Constancio et al (13),
Haldrup et al (14) and
Ried et al (15).

Figure 4

Forest plot of the specificity of the
blood biopsy studies. The studies included were the following:
Constancio et al (13),
Haldrup et al (14) and
Ried et al (15).

Figure 5

Forest plot of the sensitivity of the
urine biopsy studies. The studies included were the following:
Constancio et al (13),
Haldrup et al (14) and
Ried et al (15). Davey
et al (24), Kim et
al (16), McKiernan et
al (17), Van Neste et
al (18) Ochiai et al
(19) Wang et al (20), Yu et al (21), Opoku Mensah et al (22) and Cheng et al (23).

Figure 6

Forest plot of the specificity of
urine biopsy studies. The studies included were the following:
Constancio et al (13),
Haldrup et al (14) and
Ried et al (15). Davey
et al (24), Kim et
al (16), McKiernan et
al (17), Van Neste et
al (18), Ochiai et al
(19), Wang et al (20), Yu et al (21), Opoku Mensah et al (22) and Cheng et al (23).

Figure 7

Specificity forest plot comparing
blood biopsy and urine biopsy studies using a random effects model.
The studies included were the following: Constancio et al
(13), Haldrup et al
(14), Ried et al (15), Davey et al (24), Kim et al (16), McKiernan et al (17), Van Neste et al (18), Ochiai et al (19), Wang et al (20), Yu et al (19), Opoku Mensah et al (22) and Cheng et al (23).

Figure 8

The sensitivity forest plot comparing
blood biopsy and urine biopsy studies using a random effect model.
The studies included were the following: Constancio et al
(13), Haldrup et al
(14), Ried et al (15), Davey et al (24), Kim et al (16), McKiernan et al (17), Van Neste et al (18), Ochiai et al (19), Wang et al (20), Yu et al (21), Opoku Mensah et al (22) and Cheng et al (23).

Figure 9

Funnel plot for specificity.

Figure 10

Funnel plot for sensitivity.

Figure 11

Summary receiver operating
characteristic curve - bivariate Reitsma model for included
studies.

Figure 12

Comparison of summary receiver
operating characteristic curve curves for blood biopsy and urine
biopsy studies.
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Copy and paste a formatted citation
Spandidos Publications style
Selanno FE, Rahman F, Mochtar CA and Hamid AR: Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis. World Acad Sci J 8: 28, 2026.
APA
Selanno, F.E., Rahman, F., Mochtar, C.A., & Hamid, A.R. (2026). Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis. World Academy of Sciences Journal, 8, 28. https://doi.org/10.3892/wasj.2026.443
MLA
Selanno, F. E., Rahman, F., Mochtar, C. A., Hamid, A. R."Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis". World Academy of Sciences Journal 8.2 (2026): 28.
Chicago
Selanno, F. E., Rahman, F., Mochtar, C. A., Hamid, A. R."Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis". World Academy of Sciences Journal 8, no. 2 (2026): 28. https://doi.org/10.3892/wasj.2026.443
Copy and paste a formatted citation
x
Spandidos Publications style
Selanno FE, Rahman F, Mochtar CA and Hamid AR: Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis. World Acad Sci J 8: 28, 2026.
APA
Selanno, F.E., Rahman, F., Mochtar, C.A., & Hamid, A.R. (2026). Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis. World Academy of Sciences Journal, 8, 28. https://doi.org/10.3892/wasj.2026.443
MLA
Selanno, F. E., Rahman, F., Mochtar, C. A., Hamid, A. R."Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis". World Academy of Sciences Journal 8.2 (2026): 28.
Chicago
Selanno, F. E., Rahman, F., Mochtar, C. A., Hamid, A. R."Role of liquid biopsy in prostate cancer diagnosis: A systematic review and meta‑analysis". World Academy of Sciences Journal 8, no. 2 (2026): 28. https://doi.org/10.3892/wasj.2026.443
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