: It has been proposed that Metabolic Syndrome causes an inadvertent lowering of PSA levels in affected individuals. OBJECTIVE: This study aimed to determine the effect of metabolic syndrome on the serum PSA level. METHODS: Literature search was done using MEDLINE and Cochrane databases. The primary outcome measure was serum prostate-specific antigen (PSA) levels. Secondary outcome measures included prostate volume, plasma volume, and PSA mass density. Mean differences were computed using Review Manager 5.3 software. RESULTS: There were six articles available for analysis with a total of 33,775 in metabolic syndrome group (MS) and 70,305 in non-metabolic syndrome group (NM). Overall, there was no significant difference between the PSA levels between MS and NM group. The prostate and plasma volume were significantly higher in the MS compared with NM, having mean difference of 2.95 mL (95% CI, 1.41 to 4.49) and 162.68 mL (95% CI, 120.24 to 205.11), respectively. However, there were no significant difference in the PSA mass density between metabolic and non-metabolic syndrome. CONCLUSION Metabolic syndrome does not affect PSA levels and PSA mass density, despite increase in hemodilution.