Prostate-Specific Antigen (PSA)-Based Population Screening for Prostate Cancer: An Evidence-Based Analysis.

Area of Science:

• Oncology
• Public Health
• Evidence-Based Medicine

Background:

• Prostate cancer (PC) is a leading cancer diagnosis in men, with prostate-specific antigen (PSA) testing widely used for over two decades.
• The effectiveness of population-based PSA screening programs for PC remains a critical public health question, particularly for healthcare policy decisions.

Purpose of the Study:

• To systematically review the scientific literature to determine the effectiveness of PSA-based population screening programs for PC.
• To provide evidence to inform policy decisions regarding PSA screening within publicly funded healthcare systems.

Main Methods:

• A systematic review of bibliographic databases was conducted, focusing on systematic reviews and randomized controlled trials (RCTs) of PSA-based PC screening.
• The search strategy aimed to identify studies reporting on PC mortality and all-cause mortality as key outcomes.

Main Results:

• The review identified 5 systematic reviews and 6 RCTs. No systematic reviews found a statistically significant reduction in PC or overall mortality with PSA screening.
• While one RCT (European) showed a statistically significant reduction in PC mortality, the absolute benefit was small, and treatment protocols varied.
• Another RCT (American PLCO) found no significant reduction, and potentially a non-significant increase, in PC mortality, with high opportunistic screening in the control group. All RCTs noted an increase in detection of low-risk PCs and no reduction in all-cause mortality.

Conclusions:

• The American PLCO trial, conducted in a setting with prevalent opportunistic screening, showed no evidence of reduced PC mortality.
• Given similar opportunistic PSA screening practices in Canada, a formal screening program is unlikely to decrease PC mortality.
• The findings suggest that widespread PSA screening may lead to overdiagnosis of low-risk prostate cancers without a clear mortality benefit.