Screening for prostate cancer

Screening based on prostate specific antigen (PSA) measurement has contributed to a dramatic increase in the number of prostate cancer cases diagnosed. In addition, most tumours are now smaller and clinically localised at diagnosis, whereas before the introduction of screening, tumours were often clinically advanced or overtly metastatic at diagnosis. However, the effects of screening on overall mortality and mortality from prostate cancer were unclear and variable in two large randomised trials.1 2 The American PLCO study found no benefit on mortality, whereas the European ERSPC trial showed a 20% reduction in prostate cancer specific mortality after 10 years in men who underwent PSA based screening.

In the linked systematic review and meta-analysis (doi:10.1136/bmj.c4543), Djulbegovic and colleagues comprehensively assessed the effects of screening for prostate cancer. The analysis of six randomised controlled trials, including the PLCO and ERSPC studies, found that screening increased the probability of being diagnosed with prostate cancer (relative risk 1.46, 95% confidence interval 1.21 to 1.77) but had no significant effect on mortality from prostate cancer (0.88, 0.71 to 1.09) or overall mortality (0.99, 0.97 to …