BACKGROUND: Prostate cancer (PC) is the most commonly diagnosed non-cutaneous cancer in men and their second or third leading cause of cancer death. Prostate-specific antigen (PSA) testing for PC has been in common practice for more than 20 years. OBJECTIVES: A systematic review of the scientific literature was conducted to determine the effectiveness of PSA-based population screening programs for PC to inform policy decisions in a publicly funded health care system. DATA SOURCES: A systematic review of bibliographic databases was performed for systematic reviews or randomized controlled trials (RCT) of PSA-based population screening programs for PC. REVIEW METHODS: A broad search strategy was employed to identify studies reporting on key outcomes of PC mortality and all-cause mortality. RESULTS: The search identified 5 systematic reviews and 6 RCTs. None of the systematic reviews found a statistically significant reduction in relative risk (RR) of PC mortality or overall mortality with PSA-based screening. PC mortality reductions were found to vary by country, by screening program, and by age of men at study entry. The European Randomized Study of Screening for Prostate Cancer found a statistically significant reduction in RR in PC mortality at 11-year follow-up (0.79; 95% CI, 0.67-0.92), although the absolute risk reduction was small (1.0/10,000 person-years). However, the primary treatment for PCs differed significantly between countries and between trial arms. The American Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) found a statistically non-significant increase in RR for PC mortality with 13-year follow-up (1.09; 95% CI, 0.87-1.36). The degree of opportunistic screening in the control arm of the PLCO trial, however, was high. None of the RCTs found a reduction in all-cause mortality and all found a statistically significant increase in the detection of mainly low-risk, organ-confined PCs in the screening arm. CONCLUSIONS: There was no evidence of a PC mortality reduction in the American PLCO trial, which investigated a screening program in a setting where opportunistic screening was already common practice. Given that opportunistic PSA screening practices in Canada are similar, it is unlikely that the introduction of a formal PSA screening program would reduce PC mortality.
BACKGROUND:Prostate cancer (PC) is the most commonly diagnosed non-cutaneous cancer in men and their second or third leading cause of cancer death. Prostate-specific antigen (PSA) testing for PC has been in common practice for more than 20 years. OBJECTIVES: A systematic review of the scientific literature was conducted to determine the effectiveness of PSA-based population screening programs for PC to inform policy decisions in a publicly funded health care system. DATA SOURCES: A systematic review of bibliographic databases was performed for systematic reviews or randomized controlled trials (RCT) of PSA-based population screening programs for PC. REVIEW METHODS: A broad search strategy was employed to identify studies reporting on key outcomes of PC mortality and all-cause mortality. RESULTS: The search identified 5 systematic reviews and 6 RCTs. None of the systematic reviews found a statistically significant reduction in relative risk (RR) of PC mortality or overall mortality with PSA-based screening. PC mortality reductions were found to vary by country, by screening program, and by age of men at study entry. The European Randomized Study of Screening for Prostate Cancer found a statistically significant reduction in RR in PC mortality at 11-year follow-up (0.79; 95% CI, 0.67-0.92), although the absolute risk reduction was small (1.0/10,000 person-years). However, the primary treatment for PCs differed significantly between countries and between trial arms. The American Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) found a statistically non-significant increase in RR for PC mortality with 13-year follow-up (1.09; 95% CI, 0.87-1.36). The degree of opportunistic screening in the control arm of the PLCO trial, however, was high. None of the RCTs found a reduction in all-cause mortality and all found a statistically significant increase in the detection of mainly low-risk, organ-confined PCs in the screening arm. CONCLUSIONS: There was no evidence of a PC mortality reduction in the American PLCO trial, which investigated a screening program in a setting where opportunistic screening was already common practice. Given that opportunistic PSA screening practices in Canada are similar, it is unlikely that the introduction of a formal PSA screening program would reduce PC mortality.
Authors: E David Crawford; Robert Grubb; Amanda Black; Gerald L Andriole; Ming-Hui Chen; Grant Izmirlian; Christine D Berg; Anthony V D'Amico Journal: J Clin Oncol Date: 2010-11-01 Impact factor: 44.544
Authors: Gerald L Andriole; David L Levin; E David Crawford; Edward P Gelmann; Paul F Pinsky; David Chia; Barnett S Kramer; Douglas Reding; Timothy R Church; Robert L Grubb; Grant Izmirlian; Lawrence R Ragard; Jonathan D Clapp; Philip C Prorok; John K Gohagan Journal: J Natl Cancer Inst Date: 2005-03-16 Impact factor: 13.506
Authors: Jan-Erik Johansson; Ove Andrén; Swen-Olof Andersson; Paul W Dickman; Lars Holmberg; Anders Magnuson; Hans-Olov Adami Journal: JAMA Date: 2004-06-09 Impact factor: 56.272
Authors: Monique J Roobol; Ries Kranse; Chris H Bangma; Arno G J L H van Leenders; Bert G Blijenberg; Ron H N van Schaik; Wim J Kirkels; Suzie J Otto; Theo H van der Kwast; Harry J de Koning; Fritz H Schröder Journal: Eur Urol Date: 2013-05-25 Impact factor: 20.096
Authors: Marcin Popiolek; Jennifer R Rider; Ove Andrén; Sven-Olof Andersson; Lars Holmberg; Hans-Olov Adami; Jan-Erik Johansson Journal: Eur Urol Date: 2012-10-13 Impact factor: 20.096
Authors: Ian M Thompson; Donna K Pauler; Phyllis J Goodman; Catherine M Tangen; M Scott Lucia; Howard L Parnes; Lori M Minasian; Leslie G Ford; Scott M Lippman; E David Crawford; John J Crowley; Charles A Coltman Journal: N Engl J Med Date: 2004-05-27 Impact factor: 91.245