Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical...

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate cancer screening is debated due to potential benefits versus harms like overdetection and overtreatment.
• The Prostate Cancer Screening Trial (CAP) aimed to clarify the impact of prostate-specific antigen (PSA) testing.

Purpose of the Study:

• To evaluate the effect of a single PSA screening intervention on prostate cancer-specific mortality.
• To assess secondary outcomes including cancer stage, grade, and all-cause mortality.

Main Methods:

• A cluster randomized trial involving 419,582 men aged 50-69 in the UK.
• Intervention group received a single PSA test invitation; control group received standard care.
• Median follow-up was 10 years, with prostate cancer-specific mortality as the primary outcome.

Main Results:

• No significant difference in prostate cancer-specific mortality between the intervention and control groups (0.30 vs 0.31 per 1000 person-years).
• Increased diagnosis of prostate cancer (4.3% vs 3.6%) and detection of low-grade (Gleason 6 or lower) tumors in the intervention group.
• No significant difference in all-cause mortality between groups.

Conclusions:

• A single PSA screening intervention did not reduce prostate cancer mortality.
• The intervention led to increased detection of low-risk prostate cancer, raising concerns about overdiagnosis.
• Findings do not support the use of single PSA testing for population-based prostate cancer screening.