2010 - Review: Prostate cancer screening using PSA does not decrease mortality

Luckmann, Roger
January 2011
ACP Journal Club;1/18/2011, Vol. 154 Issue 1, p1
Academic Journal
Question In asymptomatic men with no history of prostate cancer (PCa), does screening using prostate-specific antigen (PSA) reduce mortality? Review scope Included studies compared screening using PSA testing, with or without digital rectal examination (DRE), with no screening in asymptomatic men with no history of PCa. Outcomes included all-cause mortality, death from PCa, and PCa diagnosis. Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials (all to Jul 2010); reference lists; and abstracts of several major scientific meetings (Jan 2005 to Jul 2010) were searched for randomized controlled trials (RCTs). 6 RCTs (n =>387>286; age range 45 to 80 y) met the selection criteria. Median follow-up ranged from 4 to 15 years. 5 studies used PSA tests to screen all participants; 1 study initially used DRE only but later added PSA testing. 4 trials had adequate randomization, 1 was quasi-randomized, and 1 was unclear about the randomization process. Main results Meta-analysis showed that screening did not reduce risk for all-cause mortality or death from PCa (Table). Screening increased diagnosis of PCa overall and for stage I, but not for stages II to IV (Table). Conclusion In asymptomatic men with no history of prostate cancer, screening using prostate-specific antigen does not reduce all-cause mortality or death from prostate cancer.


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