Ann Lab Med.  2013 Jul;33(4):233-241. 10.3343/alm.2013.33.4.233.

Is Prostate-Specific Antigen Effective for Population Screening of Prostate Cancer? A Systematic Review

• Lee YJ
• Park JE
• Jeon BR
• Lee SM
• Kim SY
• Lee YK

• KMID: 1707229
• DOI: http://doi.org/10.3343/alm.2013.33.4.233

Abstract

BACKGROUND
The effectiveness of prostate-specific antigen (PSA) for population screening has presented controversial results in large trials and prior reviews. We investigated the effectiveness of PSA population screening in a systematic review.
METHODS
The study was conducted using existing systematic reviews. We searched Ovid MEDLINE, Embase, Cochrane library, and the major Korean databases. The quality of the systematic reviews was assessed by two reviewers independently using AMSTAR. Randomized controlled trials were assessed using the risk of bias tool in the Cochrane group. Meta-analyses were conducted using Review Manager. The level of evidence of each outcome was assessed using GRADE.
RESULTS
Prostate-cancer-specific mortality was not reduced based on similar prior reviews (relative risk [RR] 0.93; 95% confidence interval [CI], 0.81-1.07, P=0.31). The detection rate of stage 1 prostate cancer was not greater, with a RR of 1.67 (95% CI, 0.95-2.94) and high heterogeneity. The detection rate of all cancer stages in the screening group was high, with a RR of 1.45 (95% CI, 1.13-1.85). No difference in all-cause mortality was observed between the screening and control groups (RR, 0.99; 95% CI, 0.98-1.01, P=0.50). Prostate-cancer-specific mortality, all-cause mortality, and diagnosis of prostate cancer at stages 3-4 showed moderate levels of evidence.
CONCLUSIONS
Differently from prior studies, our review included updated Norrkoping data and assessed the sole effect of PSA testing for prostate cancer screening. PSA screening alone did not increase early stage prostate cancer detection and did not lower mortality.

Keyword

Prostatic neoplasm; Mass screening; Mortality; Prostate specific antigen; Review; Meta-analysis

MeSH Terms

Clinical Trials as Topic
Databases, Factual
Humans
Male
Mass Screening
Neoplasm Staging
Prostate-Specific Antigen/*analysis
Prostatic Neoplasms/*diagnosis/mortality
Prostate-Specific Antigen

Figure

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  Fig. 1 Flow diagram.Abbreviations: RCT, Randomized controlled trial; CRD, Centre for Reviews and Dissemination.

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  Fig. 2 Risks of bias in the prostate-specific antigen (PSA) trials.

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