"PSA screening alone did not increase early stage prostate cancer detection and did not lower mortality"

http://www.ncbi.nlm.nih.gov/pubmed/23826558

Ann Lab Med. 2013 Jul;33(4):233-41. doi: 10.3343/alm.2013.33.4.233. Epub 2013 Jun 24.

Is prostate-specific antigen effective for population screening of prostate cancer? A systematic review.

Lee YJ, Park JE, Jeon BR, Lee SM, Kim SY, Lee YK.

Source

Department of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea. ; Department of Oriental Gynecology, Bundang CHA Medical Center, CHA University, Seongnam, Korea.

Abstract

BACKGROUND:

The effectiveness of prostate-specific antigen (PSA) for population screening has presented controversial results in large trials and prior reviews. We investigated the effectiveness of PSA population screening in a systematic review.

METHODS:

The study was conducted using existing systematic reviews. We searched Ovid MEDLINE, Embase, Cochrane library, and the major Korean databases. The quality of the systematic reviews was assessed by two reviewers independently using AMSTAR. Randomized controlled trials were assessed using the risk of bias tool in the Cochrane group. Meta-analyses were conducted using Review Manager. The level of evidence of each outcome was assessed using GRADE.

RESULTS:

Prostate-cancer-specific mortality was not reduced based on similar prior reviews (relative risk [RR] 0.93; 95% confidence interval [CI], 0.81-1.07, P=0.31). The detection rate of stage 1 prostate cancer was not greater, with a RR of 1.67 (95% CI, 0.95-2.94) and high heterogeneity. Thedetection rate of all cancer stages in the screening group was high, with a RR of 1.45 (95% CI, 1.13-1.85). No difference in all-cause mortality was observed between the screening and control groups (RR, 0.99; 95% CI, 0.98-1.01, P=0.50). Prostate-cancer-specific mortality, all-cause mortality, and diagnosis of prostate cancer at stages 3-4 showed moderate levels of evidence.

CONCLUSIONS:

Differently from prior studies, our review included updated Norrköping data and assessed the sole effect of PSA testing for prostatecancer screening. PSA screening alone did not increase early stage prostate cancer detection and did not lower mortality.