Randomized trials of PSA screening

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate-specific antigen (PSA) testing's role in prostate cancer (PCa) screening has evolved, with randomized controlled trials (RCTs) influencing guidelines.
• Current controversy surrounds PSA screening due to the indolent nature of many PCa cases and risks of overdiagnosis and overtreatment.

Purpose of the Study:

• To review major RCTs evaluating PSA screening to inform clinical practices.
• To analyze the impact of PSA screening on prostate cancer mortality and incidence.

Main Methods:

• Summarized findings from primary RCTs: Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, European Randomized Study of Screening for Prostate Cancer (ERSPC), and Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP).
• Evaluated PSA screening's effect on PCa mortality and incidence, noting study limitations like contamination and low compliance.

Main Results:

• PLCO and CAP trials showed no significant difference in PCa mortality.
• ERSPC trial reported a 20% reduction in PCa mortality at 9 years and a decrease in metastatic disease.
• PLCO trial indicated increased detection of Gleason 6 and decreased detection of Gleason 8-10 disease in the screening group.

Conclusions:

• Differences in trial outcomes are attributed to variations in design, contamination, adherence, and PSA thresholds.
• Further research is needed to optimize screening intervals, target high-risk groups, and integrate non-invasive tools for improved efficacy and reduced harms.