- 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.
- Meta-analysis of 5 randomized controlled trials including 721,718 men.
- Funding: None.
- 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).
- Low- and moderate-quality evidence.