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Word of the Day

PSA screening does not decrease mortality

Clinical Question:
Does screening for prostate cancer decrease overall mortality or mortality from prostate cancer?

Bottom Line:
In the past 4 years, the results from 4 randomized studies enrolling more than 350,000 men have confirmed previous research: Screening for prostate cancer with prostate-specific antigen testing in asymptomatic men does not decrease all-cause or prostate cancer-related mortality. (LOE = 1a)

Reference:
Djulbegovic M, Beyth RJ, Neuberger MM, et al. Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials. BMJ 2010;341:c4543 doi:10.1136/bmj.c4543.  [PMID:20843937]

Study Design:
Meta-analysis (randomized controlled trials)

Funding:
Self-funded or unfunded

Setting:
Various (meta-analysis)

Synopsis:
This analysis updates a systematic review of 2 studies published in 2006 in the Cochrane Library. Since that review, an additional 4 studies have been completed enrolling a total of 351,531 patients. These authors identified all 6 randomized trials comparing screening with no screening in asymptomatic men using several databases, including the Cochrane Registry of Controlled Trials, with 2 investigators independently performing searches and abstracting the data. The authors also searched abstracts of relevant meetings. A single study provided 46% of the total number of patients. Study quality was only moderate for most of the studies. Four studies assessed the effect of screening on all-cause mortality, finding no benefit to screening when patients were followed up from 9 years to 14 years. Death from prostate cancer was also not decreased by screening, though there was heterogeneity among the studies. No surprise, the diagnosis of prostate cancer was almost 50% more likely in the screened men.

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