Randomized trial results did not resolve controversies surrounding prostate cancer screening

Prostate cancer screening remains controversial. This review will address recently published results from randomized controlled screening trials as well as current practice guidelines.

The Prostate Lung Colorectal and Ovarian Cancer Screening Trial found that screening did not decrease prostate cancer mortality after 7 years of follow-up. High-screening rates in the control group, the low number of deaths from prostate cancer, and the relatively short follow-up duration contributed to the negative results. The European Randomized Study of Screening for Prostate Cancer found that screening reduced prostate cancer mortality by 20% during a median 9 years of follow-up. However, the absolute benefit (0.7/1000 reduction) was small and was associated with a 70% increase in prostate cancer diagnosis. Subsequently, the American Urological Association recommended beginning screening at the age of 40 years and not relying on a specific prostate-specific antigen cutoff for biopsy referral. The United States Preventive Services Task Force and American Cancer Society have yet to issue updated guidelines.

The randomized trials suggest that screening at best will have a small survival benefit but substantial potential risk for overdiagnosis and overtreatment. Patients need to understand these tradeoffs in order to make informed decisions about screening.