Prostate cancer (PC) is the most commonly diagnosed non-cutaneous cancer in men and their second or third leading cause of cancer death. Prostate-specific antigen (PSA) testing for PC has been in common practice for more than 20 years.
OBJECTIVES:
A systematic review of the scientific literature was conducted to determine the effectiveness of PSA-based population screening programs for PC to inform policy decisions in a publicly funded health care system.
DATA SOURCES:
A systematic review of bibliographic databases was performed for systematic reviews or randomized controlled trials (RCT) of PSA-based population screening programs for PC.
REVIEW METHODS:
A broad search strategy was employed to identify studies reporting on key outcomes of PC mortality and all-cause mortality.
RESULTS:
The search identified 5 systematic reviews and 6 RCTs. None of the systematic reviews found a statistically significant reduction in relative risk (RR) of PC mortality or overall mortality with PSA-based screening. PC mortality reductions were found to vary by country, by screening program, and by age of men at study entry. The European Randomized Study of Screening for Prostate Cancer found a statistically significant reduction in RR in PC mortality at 11-year follow-up (0.79; 95% CI, 0.67-0.92), although the absolute risk reduction was small (1.0/10,000 person-years). However, the primary treatment for PCs differed significantly between countries and between trial arms. The American Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) found a statistically non-significant increase in RR for PC mortality with 13-year follow-up (1.09; 95% CI, 0.87-1.36). The degree of opportunistic screening in the control arm of the PLCO trial, however, was high. None of the RCTs found a reduction in all-cause mortality and all found a statistically significant increase in the detection of mainly low-risk, organ-confined PCs in the screening arm.
CONCLUSIONS:
There was no evidence of a PC mortality reduction in the American PLCO trial, which investigated a screening program in a setting where opportunistic screening was already common practice. Given that opportunistic PSA screening practices in Canada are similar, it is unlikely that the introduction of a formal PSA screening program would reduce PC mortality.
BACKGROUND: L'efficacia di antigene prostatico specifico (PSA) per lo screening della popolazione ha presentato risultati controversi in grandi prove e recensioni precedenti. Abbiamo studiato l'efficacia dello screening di popolazione PSA in una revisione sistematica.
METODI: Lo studio è stato condotto utilizzando revisioni sistematiche esistenti. Abbiamo cercato Ovid MEDLINE, Embase, Cochrane Library, e le principali banche dati coreani. La qualità delle revisioni sistematiche è stato valutato da due revisori indipendenti che utilizzano AMSTAR. Studi randomizzati controllati sono stati valutati utilizzando il rischio di parzialità strumento nel gruppo Cochrane. Meta-analisi sono state condotte utilizzando Review Manager. Il livello di evidenza di ogni risultato è stato valutato usando GRADO.
RISULTATI: mortalità Prostate-cancro-specifica non è stata ridotta basato su simili recensioni precedenti (rischio relativo [RR] 0,93; 95% intervallo di confidenza [IC], 0,81-1,07, p = 0,31). Il tasso di rilevamento di fase 1 cancro alla prostata non è stato maggiore, con un RR di 1.67 (95% CI, 0,95-2,94) e alta eterogeneità. Il tasso di rilevamento di tutte le fasi di cancro nel gruppo di screening era alta, con un RR di 1,45 (95% CI, 1,13-1,85). Nessuna differenza in tutte le cause di mortalità è stata osservata tra i gruppi di screening e di controllo (RR, 0,99; 95% CI, 0,98-1,01, p = 0,50). Mortalità Prostate--cancro-specifica, per tutte le cause di mortalità, e la diagnosi di cancro alla prostata nelle fasi 3-4 mostravano livelli moderati di prove.
CONCLUSIONI: A differenza di studi precedenti, la nostra recensione inclusi aggiornati dati Norrköping e valutato l'unico effetto di test PSA per lo screening del cancro della prostata. Lo screening PSA da solo non ha aumentato la diagnosi precoce del cancro alla prostata palco e ha fatto la mortalità non inferiori.
Prostate cancer (PC) is the most commonly diagnosed non-cutaneous cancer in men and their second or third leading cause of cancer death. Prostate-specific antigen (PSA) testing for PC has been in common practice for more than 20 years.
OBJECTIVES:
A systematic review of the scientific literature was conducted to determine the effectiveness of PSA-based population screening programs for PC to inform policy decisions in a publicly funded health care system.
DATA SOURCES:
A systematic review of bibliographic databases was performed for systematic reviews or randomized controlled trials (RCT) of PSA-based population screening programs for PC.
REVIEW METHODS:
A broad search strategy was employed to identify studies reporting on key outcomes of PC mortality and all-cause mortality.
RESULTS:
The search identified 5 systematic reviews and 6 RCTs. None of the systematic reviews found a statistically significant reduction in relative risk (RR) of PC mortality or overall mortality with PSA-based screening. PC mortality reductions were found to vary by country, by screening program, and by age of men at study entry. The European Randomized Study of Screening for Prostate Cancer found a statistically significant reduction in RR in PC mortality at 11-year follow-up (0.79; 95% CI, 0.67-0.92), although the absolute risk reduction was small (1.0/10,000 person-years). However, the primary treatment for PCs differed significantly between countries and between trial arms. The American Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) found a statistically non-significant increase in RR for PC mortality with 13-year follow-up (1.09; 95% CI, 0.87-1.36). The degree of opportunistic screening in the control arm of the PLCO trial, however, was high. None of the RCTs found a reduction in all-cause mortality and all found a statistically significant increase in the detection of mainly low-risk, organ-confined PCs in the screening arm.
CONCLUSIONS:
There was no evidence of a PC mortality reduction in the American PLCO trial, which investigated a screening program in a setting where opportunistic screening was already common practice. Given that opportunistic PSA screening practices in Canada are similar, it is unlikely that the introduction of a formal PSA screening program would reduce PC mortality.