Screening for prostate cancer: an updated Cochrane systematic review

Abstract

OBJECTIVE• To determine whether screening for prostate cancer reduces prostate cancerspecific mortality, impact on all-cause mortality and patient health-related quality of life. MATERIALS AND METHODS• An update to our 2006 Cochrane systematic review was performed by rerunning an updated search of several databases, including MEDLINE and the Cochrane CENTRAL Register of Controlled Trials.• Articles were included if they were a randomized controlled trial (RCT) examining screening vs no screening for prostate cancer. Data was collected and analysed according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS• Five RCTs with a total of 341 351 participants were included in this updated Cochrane systematic review. All involved PSA testing, although the interval and threshold for further evaluation varied across trials. The age of participants was 50-74 years, with durations of patient follow-up of 7-15 years.• The methodological quality of three of the studies was assessed as posing a high risk of bias.• Meta-analysis of the five included studies indicated no statistically significant difference in prostate cancer-specific mortality between men randomized to screening and control [relative risk (RR) 0.95, 95% CI 0.85-1.07]. Sub-group analyses indicated that prostate cancerspecific mortality was not affected by age at which participants were screened. A preplanned analysis of a 'core' age group of men aged 55-69 years from the largest RCT ( European Randomised Study of Screening for Prostate Cancer ) reported a significant 20% relative reduction in prostate cancerspecific mortality; (95% CI 0.65-0.98; absolute risk 0.71 per 1000 men). The number of men diagnosed with prostate cancer was significantly greater in men randomized to screening, compared with those randomized to control (RR 1.35, 95% CI 1.06-1.72).• Harms of screening included high rates of false-positive results for the PSA test, over-diagnosis and adverse events associated with transrectal ultrasonography guided biopsies such as infection, bleeding and pain.

Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program

“…On a global level the incidence and prevalence of prostate cancer varies more than 25-fold worldwide, with highest incidence in developed countries of North America, Europe and Australia, and lower incidence rates in underdeveloped countries. These differences may occur due to the increased levels of screening and testing for prostate cancer in these developed countries (1)(2)(3).…”

Multigene panels in prostate cancer risk assessment: a systematic review

“…The most important limitation with PSA-based screening is its lack of specificity (i.e., a high rate of false positives). [15][16][17] Improving this by using SNP-based panels would reduce unnecessary diagnostic investigations and their associated morbidity and costs. However, this would be successful only if patients were willing to trust negative screen results, given a prevailing culture that seems to promote higher levels of screening as "better" screening practice.…”

“…The value of aggressive management for localized prostate cancer is debated, [11][12][13][14] and only a small proportion of men with early-stage prostate cancer die from the disease within 10 to 15 years of diagnosis. Developing tools to differentiate aggressive and indolent disease is of key importance.Prostate-specific antigen (PSA) screening was introduced in the late 1980s.15 Meta-analyses of seven randomized controlled trials (RCTs) of screening using PSA testing alone or in combination with digital rectal examination suggested no evidence of benefit in reducing mortality 16,17 and some evidence of harm from overdiagnosis.17 Amid substantial debate, 18-20 the argument has been made for developing more accurate screening tests, including possible genetic markers. Purpose: Single-nucleotide polymorphism (SNP) panel tests have been proposed for use in the detection of, and prediction of risk for, prostate cancer and as prognostic indicator in affected men.…”

“…15 Meta-analyses of seven randomized controlled trials (RCTs) of screening using PSA testing alone or in combination with digital rectal examination suggested no evidence of benefit in reducing mortality 16,17 and some evidence of harm from overdiagnosis.…”

Prostate cancer: the need for biomarkers and new therapeutic targets

“…Nonetheless, the use of PSA screening is controversial because the early detection of PCa based on this measurement can lead to the diagnosis and treatment of PCa cases that would not otherwise cause symptoms or threaten life (Schröder et al, 2006;Lumen et al, 2012). Recently published data suggest that PSA-based screening results in the detection of more cases of PCa, but the effects on PCa mortality are minimal or non-existent (Djulbegovic et al, 2010;Ilic et al, 2011). These findings are aggravated when considering that PCa treatment can have major side effects, including urinary incontinence and sexual impotence.…”