Trials of prostate-cancer screening are not worthwhile

Radical Prostatectomy versus Observation for Localized Prostate Cancer

“…These findings highlight the limitations of using prostate-cancer mortality as an outcome, even with the use of adjudication committees whose members are unaware of treatment assignments and who are following standardized protocols. [25][26][27] The effect of radical prostatectomy on mortality did not vary according to age, race, self-reported performance status, or coexisting conditions, but our findings suggest that it may vary according to PSA value and possibly tumor risk. Positive results were from multiple subgroup comparisons; the tests of interaction typically approached but did not reach significance and may therefore be due to chance.…”

“…Our choice of all-cause mortality as the primary outcome underscores the importance of improving life expectancy with cancer treatment and eliminates the possibility of biased cause-of-death ascertainment. [25][26][27] Our study was conducted in the early era of PSA testing. The current practices of performing repeated PSA testing, using a lower PSA threshold for biopsy, obtaining more tissue-biopsy cores, and performing a repeat biopsy after initially negative findings increase the detection of smallervolume indolent cancers.…”

Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

“…Thus, the key consequence of overdiagnosis is overtreatment, which in turn, can cause side-effects such as impotence and incontinence and might even increase allcause mortality. 16 The proportion of overdiagnosed cancers depends on several factors including patient age, frequency of screening and definition of overdiagnosis. Using modelling studies, based on results from a PSA screening study, Draisma et al 17 calculated that a single screen at 55 years of age resulted in an overdetection rate of 27%, while at age 75, it was 56%.…”

Benefits and Risks of Prostate Cancer Screening

“…This does not mean that there is evidence that screening does not affect overall mortality: In fact, none of the trials were powered to detect such an effect. It would take a sample of 3,000,000 participants for an 80% power to detect a possible screening-related reduction in overall mortality [33]. Trials of such a size would not be manageable.…”

“…Overall mortality, however, is a more relevant endpoint because it takes into account possible adverse effects of screening and misattribution of the cause of death [57]. Dubben [33] pointed out that it would be nearly impossible to show an advantage for PCa screening regarding overall mortality because of the sheer number of participants needed. Besides, the effect of screening will not have an immediate impact on survival but will be evident only after many years.…”