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Got It, Hide thisScreening for prostate cancer may reduce death due to prostate cancer but has associated harms
Bell N, Connor Gorber S, Shane A, et al. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ. 2014;186:1225-34.
Review question
What are the benefits and harms of screening men for prostate cancer using the prostate-specific-antigen (PSA) test?
Background
Prostate cancer is one of the most commonly diagnosed cancers in men. Most prostate cancers are slow growing and not life-threatening. The PSA test and digital rectal examination are used to screen for prostate cancer. Screening can lead to detection of cancers that would not progress to cause symptoms or death. Men with positive screening tests often have further, more invasive tests, such as prostate biopsy. For men with a prostate cancer diagnosis, the survival rate is 95% at 10 years.
How the review was done
The researchers did a systematic review, searching for studies that were published up to August 2014.
They found 3 randomized controlled trials of sufficient quality, with over 200,000 men.
The trials assessed the benefits and harms of screening for prostate cancer using the PSA test in men who did not have symptoms of prostate cancer.
Screening was compared with no screening or usual care in the general population.
Men who had previous PSA tests were included.
What the researchers found (Table)
No studies included digital rectal examination, alone or with PSA screening.
Screening for prostate cancer with PSA may reduce death due to prostate cancer but it does not reduce death due to any cause.
PSA screening falsely indicates prostate cancer in some men and also detects a number of cases that would not cause symptoms or death because they are growing slowly.
Because of the errors of PSA screening, men with positive tests usually go on to have a prostate biopsy, done with a needle. Prostate biopsy can cause harms, such as blood in the urine, infection, hospital admission, and death.
Conclusions
Screening men for prostate cancer using the prostate-specific-antigen test may reduce death due to prostate cancer, but it does not reduce death due to any cause. Tests to confirm the results of positive PSA tests can have adverse effects.
Effects of prostate screening in men without symptoms
| Outcome | Effects of screening | Quality of evidence |
| Death due to prostate cancer | 2 trials found that screening reduced death due to prostate cancer 1 study found no effect | Moderate |
| Death due to any cause | Screening did not affect death from any cause | Moderate |
| Overdiagnosis | 40% to 56% of cases of prostate cancer that were detected would not progress to cause symptoms or death | Very low |
| False-positive test results | 11% to 20% of men who had positive screening tests did not have prostate cancer | Very low |
| Harms of prostate biopsy following positive screening tests | After prostate biopsy: 310 men out of 1000 had blood in the urine 9 men out of 1000 had an infection 21 men out of 1000 were hospitalized 2 men out of 1000 died | Very low |
Related Topics
Glossary
A test result that suggests the presence of a disease which turns out not to be there.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
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