Elevated prostate specific antigen due to indwelling urethral catheterisation: myth or fact? A systematic review and meta-analysis.

Abstract / Summary

Prostate-specific antigen (PSA) testing is central to prostate cancer diagnosis, yet values may be confounded by urethral catheterisation. Misinterpretation of PSA rises can prompt unnecessary investigations or delay critical diagnoses. We systematically evaluated what the effect of urethral catheterisation in adult men is on serum PSA levels when compared to pre-catheterisation values. A systematic search of PubMed, Embase, and Scopus through July 2025 was conducted in accordance with PRISMA guidelines. Eligible studies included adult males with pre- and post-catheterisation PSA values amongst other criteria. Pooled mean differences were calculated with a random-effects model. Study quality was further assessed using the NIH/NHLBI Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Of the 1677 records identified, ten pre-post studies met the inclusion criteria, of which nine were eligible for quantitative meta-analyses comprising 386 patients. Seven studies assessed PSA within 24 h of catheterisation. Pooled analysis demonstrated a statistically significant mean increase of 0.48 ng/mL (95% CI 0.23-0.74, p < 0.001). For catheterisation lasting 24-72 h, pooled analysis of seven studies similarly showed a significant increase of 0.33 ng/mL (95% CI 0.17-0.50, p < 0.001). Beyond 72 h, the pooled estimates of PSA change were imprecise and statistically insignificant (mean difference 1.70ng/mL, 95% CI -0.92-4.32, p = 0.20). Overall, the nine studies have demonstrated a statistically significant mean increase of 0.69 ng/mL (95% CI 0.35-1.03, p < 0.001). Further subgroup analyses in patients with urinary retention yielded statistically insignificant rises, and patients who did not have retention of urine demonstrated a statistically significant yet minimal mean increase of 0.28 ng/mL (95% CI 0.20-0.36, p < 0.001) that is likely of limited clinical relevance. Most studies were judged to be of fair methodological quality with common limitations including small sample sizes and potential confounding by underlying pathologies, amongst others. Indwelling Urethral Catheter placement for up to 72 h is associated with a statistically significant but clinically small and modest rise in serum PSA. These findings suggest that short-term catheterisation is unlikely to meaningfully distort PSA-based clinical decision-making. However, PSA interpretation in patients with prolonged catheterisation (≥ 72 h) remains uncertain, highlighting the need for further prospective studies to define optimal testing intervals.

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