Screening for prostate cancer: an updated Cochrane systematic review
Top Cited Papers
- 10 March 2011
- journal article
- review article
- Published by Wiley in BJU International
- Vol. 107 (6), 882-891
- https://doi.org/10.1111/j.1464-410x.2010.10032.x
Abstract
OBJECTIVE center dot To determine whether screening for prostate cancer reduces prostate cancer-specific mortality, impact on all-cause mortality and patient health-related quality of life. MATERIALS AND METHODS center dot An update to our 2006 Cochrane systematic review was performed by re-running an updated search of several databases, including MEDLINE and the Cochrane CENTRAL Register of Controlled Trials. center dot 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 center dot 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. center dot The methodological quality of three of the studies was assessed as posing a high risk of bias. center dot 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 cancer-specific mortality was not affected by age at which participants were screened. A pre-planned 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 cancer-specific 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). center dot 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. CONCLUSIONS center dot Prostate cancer screening did not significantly decrease all-cause or prostate cancer-specific mortality in a combined meta-analysis of five RCTs. center dot Any benefits from prostate cancer screening may take > 10 years to accrue; therefore, men who have a life expectancy of < 10-15 years should be informed that screening for prostate cancer is not beneficial and has harms.Keywords
This publication has 30 references indexed in Scilit:
- 15-Year Followup of a Population Based Prostate Cancer Screening StudyJournal of Urology, 2009
- Mortality Results from a Randomized Prostate-Cancer Screening TrialThe New England Journal of Medicine, 2009
- Screening and Prostate-Cancer Mortality in a Randomized European StudyThe New England Journal of Medicine, 2009
- Risk factors for prostate cancerNature Reviews Endocrinology, 2009
- Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: the Scandinavian Prostate Cancer Group-4 Randomized TrialJNCI Journal of the National Cancer Institute, 2008
- Radical Prostatectomy versus Watchful Waiting in Early Prostate CancerThe New England Journal of Medicine, 2005
- Clinical Consequences of Screening for Prostate Cancer: 15 Years Follow-up of a Randomised Controlled Trial in SwedenEuropean Urology, 2004
- Screening decreases prostate cancer mortality: 11‐year follow‐up of the 1988 Quebec prospective randomized controlled trialThe Prostate, 2004
- Screening and treatment of localized prostate cancer decreases mortality: First analysis of the first prospective and randomized study on prostate cancer screeningThe Aging Male, 1999
- Repeated Screening for Carcinoma of the Prostate by Digital Rectal Examination in a Randomly Selected PopulationActa Oncologica, 1992