Philipp Dahm, MD, MHSc, FACS
Does prostate-specific antigen (PSA)–based screening reduce risk for prostate cancer mortality or all-cause mortality? What are the harms?
Included studies evaluated PSA-based screening for prostate cancer in asymptomatic men. Studies of treatment in clinically localized prostate cancer were also considered, but these results are not reported in this abstract. Outcomes were all-cause mortality, prostate cancer mortality, and screening-related harms.
MEDLINE (2002 to Jul 2011), Cochrane Library (2011, Issue 2), and reference lists were searched for English-language, randomized controlled trials (RCTs). 5 RCTs (n = 9026 to 182 160, age 45 to 80 y, median follow-up 6.3 to 14 y) met inclusion criteria; 1 site from a multisite RCT reported additional data separately. Data were not pooled.
PSA-based screening did not reduce prostate cancer mortality or all-cause mortality in any RCT (Table). In a subgroup analysis from a multisite RCT and from a single site in the same RCT, PSA-based screening reduced prostate cancer mortality in men < 70 years of age (Table). 1 in 8 screened participants had false-positive results after 3 to 4 PSA tests in 2 RCTs, and 5.5% of those with false-positive results had ≥ 1 biopsy in 1 RCT (Table).
Prostate-specific antigen–based screening does not reduce risk for prostate cancer mortality or all-cause mortality.
PSA-based screening for prostate cancer vs no screening or usual care*
*NNS = number needed to screen; PSA = prostate-specific antigen; RCT = randomized controlled trial; other abbreviations defined in Glossary. RRR and CI calculated from RRs in article. Unless otherwise stated, evidence was rated as fair-quality based on US Preventive Services Task Force criteria (poor, fair, or good).
†Includes 3 poor-quality RCTs (n = 82 716).
‡Schröder FH, Hugosson J, Roobol MJ, et al; ERSPC Investigators. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-8. 19297566
§40% of patients were not included in the multisite RCT report.
||Excludes prostate cancer mortality in 1 RCT and prostate, lung, or colorectal cancer mortality in another RCT.
¶Includes 2 poor-quality RCTs (n = 36 230).
Dahm P. Review: PSA-based screening does not reduce prostate cancer mortality or all-cause mortality. Ann Intern Med. ;156:JC4–2. doi: 10.7326/0003-4819-156-8-201204170-02002
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Published: Ann Intern Med. 2012;156(8):JC4-2.
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