No evidence for benefit of PSA as a screen

January 01, 0001

No evidence for benefit of PSA as a screen

Screening for prostate cancer has become a controversial topic. These US investigators looked at the benefits and harms of screening for prostate cancer with prostate specific antigen with or without digital rectal examination. They performed a systematic review and meta-analysis of randomised controlled trials. Medline, Embase, CENTRAL, abstract proceedings, and resultant reference lists up to July 2010 were utilized. Mantel-Haenszel and inverse variance estimates were calculated and pooled under a random effects model.

The researchers found: "Six randomised controlled trials with a total of 387?286 participants that met inclusion criteria were analysed. Screening was associated with an increased probability of receiving a diagnosis of prostate cancer (relative risk 1.46) and stage I prostate cancer (1.95). There was no significant effect of screening on death from prostate cancer (0.88) or overall mortality (0.99). All trials had one or more substantial methodological limitations. None provided data on the effects of screening on participants’ quality of life. Little information was provided about potential harms associated with screening."

The researchers concluded: "The existing evidence from randomised controlled trials does not support the routine use of screening for prostate cancer with prostate specific antigen with or without digital rectal examination."

This meta-analysis found while screening with prostate specific antigen did find more cancers, it did not have a mortality benefit.

For the full abstract, click here.

BMJ 341:c4543, 14 September 2010 © 2010 Djulbegovic et al.
Screening for prostate cancer: systematic review and meta- analysis of randomised controlled trials. Mia Djulbegovic, Rebecca J Beyth, Molly M Neuberger, et al. Correspondence to P Dahm: [email protected]

Category: Y. Male Genital System. Keywords: prostate cancer, PSA, prostate specific antigen, digital rectal examination, mortality, systematic review and meta-anaylsis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 12 October 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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