Prostate-specific antigen (PSA) test for prostate cancer screening

Area of Science:

• Urology
• Oncology
• Preventive Medicine
• Evidence-Based Medicine

Background:

• Prostate cancer screening's efficacy and mortality reduction remain debated.
• Previous reviews indicated no significant mortality benefit from screening.
• New large trials and extended follow-up data necessitate an updated review.

Purpose of the Study:

• To evaluate the impact of prostate cancer screening versus no screening on mortality and diagnosis.
• To assess critical outcomes including prostate cancer-specific mortality, overall mortality, and adverse events.
• To analyze important outcomes such as quality of life and stage-specific cancer diagnoses.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Inclusion of six RCTs with 789,086 participants aged 45-80.
• Data synthesis using random-effects models, assessing evidence certainty with GRADE.

Main Results:

• Prostate-specific antigen (PSA) screening likely reduces prostate cancer-specific mortality (moderate-certainty evidence).
• Screening may slightly reduce overall mortality (low-certainty evidence) but has little effect on adverse events.
• Screening significantly increases prostate cancer diagnoses, including localized stages, but has less impact on advanced stages.

Conclusions:

• Prostate cancer screening, particularly PSA-based, appears to reduce prostate cancer-specific mortality.
• Evidence on overall mortality reduction is less certain, and harms require further investigation.
• Emerging screening methods (kallikrein, MRI) show potential but lack sufficient mortality data.