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BMJ 2009; 338 doi: (Published 25 March 2009) Cite this as: BMJ 2009;338:b1181

Trials fail to resolve PSA controversy

Twenty years after the first tests for prostate specific antigen (PSA), we still have no clear answer to the question, does screening men for prostate cancer do more good than harm? Two long awaited trials have reached different conclusions—one essentially positive, one essentially negative. Neither trial reports an unambiguous or definitive result for mortality, says an editorial (p 1351). Both could reasonably be criticised for reporting too early and leaving doctors and the “worried well” to deal with the confusion.

The European trial studied 162 243 men and compared screening with PSA measurement every four years with no screening. There were 20% fewer deaths from prostate cancer in the screened group after nine years (rate ratio 0.8, 95% CI 0.65 to 0.98), or seven fewer deaths for every 10 000 men screened.

The 76 693 men in the US trial had usual care or were screened with PSA tests and rectal examinations every year. Screening made no significant difference to deaths from prostate cancer over seven years (1.13, 0.75 to 1.70).

Overdiagnosis was a problem for screened men in both trials. Screening led to extra investigations and invasive treatments, including radical prostatectomies. In the European trial, an extra 48 men were treated for prostate cancer for every life saved.

Data on quality of life and cost effectiveness are on the way and should help clarify the benefits and harms of screening, says the editorial. For now, the harms look more obvious than the benefits.

New vaccine against CMV cuts women’s risk of infection by half

The herpes virus, cytomegalovirus (CMV), passes from mother to child during pregnancy and can cause serious congenital defects. Seronegative women need a vaccine, and one candidate—developed from a viral protein and a new adjuvant MF59—was recently tested in a phase II trial. Vaccinated women had significantly fewer CMV infections than women given placebo injections (8% (18/225) v …

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