PSA screening does not improve long-term survival

  • Ilic D & al.
  • BMJ
  • 5 Sep 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • PSA screening for prostate cancer leads to little improvement in disease-specific mortality over the course of 10 years and has no effect on all-cause mortality.

Why this matters

  • Clinicians and patients considering PSA screening should weigh benefits against potential harms of screening.

Study design

  • Meta-analysis of 5 randomized controlled trials including 721,718 men.
  • Funding: None.

Key results

  • Screening has no significant effect on all-cause mortality (4 studies; incidence rate ratio [IRR], 0.99; 95% CI, 0.98-1.01; I2=0%).
    • Sensitivity analysis of studies with low risk for bias: IRR, 1.0; 95% CI, 0.98-1.02.
  • PSA screening has no effect on cancer-specific mortality (5 studies; IRR, 0.96; 95% CI, 0.85-1.08; I2=58%).
    • In sensitivity analysis, PSA screening showed reduction in the prostate cancer incidence: IRR, 0.79 (95% CI, 0.69-0.91), corresponding to 1 fewer death per 1000 participants over the course of 10 years.
  • Screening may increase the detection of prostate cancer:
    • Any stage: IRR, 1.23; 95% CI, 1.03-1.48; I2=99%.
    • Localized: risk ratio, 1.39; 95% CI, 1.09-1.79; I2=99%.
  • QoL was not significantly different in patients undergoing PSA screening vs no screening (mean difference, 0.01; 95% CI, 0.01-0.02).

Limitations

  • Low- and moderate-quality evidence.

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