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Evidence Summary

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Screening for prostate cancer may reduce death due to prostate cancer but has associated harms

Bell N, Connor Gorber S, Shane A, et al. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ. 2014;186:1225-34.

Review question

What are the benefits and harms of screening men for prostate cancer using the prostate-specific-antigen (PSA) test?

Background

Prostate cancer is one of the most commonly diagnosed cancers in men. Most prostate cancers are slow growing and not life-threatening. The PSA test and digital rectal examination are used to screen for prostate cancer. Screening can lead to detection of cancers that would not progress to cause symptoms or death. Men with positive screening tests often have further, more invasive tests, such as prostate biopsy. For men with a prostate cancer diagnosis, the survival rate is 95% at 10 years.

How the review was done

The researchers did a systematic review, searching for studies that were published up to August 2014.

They found 3 randomized controlled trials of sufficient quality, with over 200,000 men.

The trials assessed the benefits and harms of screening for prostate cancer using the PSA test in men who did not have symptoms of prostate cancer.

Screening was compared with no screening or usual care in the general population.

Men who had previous PSA tests were included.

What the researchers found (Table)

No studies included digital rectal examination, alone or with PSA screening.

Screening for prostate cancer with PSA may reduce death due to prostate cancer but it does not reduce death due to any cause.

PSA screening falsely indicates prostate cancer in some men and also detects a number of cases that would not cause symptoms or death because they are growing slowly.

Because of the errors of PSA screening, men with positive tests usually go on to have a prostate biopsy, done with a needle. Prostate biopsy can cause harms, such as blood in the urine, infection, hospital admission, and death.

Conclusions

Screening men for prostate cancer using the prostate-specific-antigen test may reduce death due to prostate cancer, but it does not reduce death due to any cause. Tests to confirm the results of positive PSA tests can have adverse effects.

Effects of prostate screening in men without symptoms

Outcome

Effects of screening

Quality of evidence

Death due to prostate cancer

2 trials found that screening reduced death due to prostate cancer

1 study found no effect

Moderate

Death due to any cause

Screening did not affect death from any cause

Moderate

Overdiagnosis

40% to 56% of cases of prostate cancer that were detected would not progress to cause symptoms or death

Very low

False-positive test results

11% to 20% of men who had positive screening tests did not have prostate cancer

Very low

Harms of prostate biopsy following positive screening tests

After prostate biopsy:

310 men out of 1000 had blood in the urine

9 men out of 1000 had an infection

21 men out of 1000 were hospitalized

2 men out of 1000 died

Very low

 




Glossary

False-positive
A test result that suggests the presence of a disease which turns out not to be there.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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Related Web Resources

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    Canadian Task Force on Preventive Health Care
    Your risk of dying from breast cancer is slightly reduced if you have regular screening. However, regular screening increases your chance of a false positive result, a biopsy and having part or all of a breast removed unnecessarily.
  • Breast cancer: Patient algorithm

    Canadian Task Force on Preventive Health Care
    The Canadian Task Force on Preventive Health Care recommends women between 50 and 74 years old who are not at high risk get screened for breast cancer every 2 to 3 years. Talk to your doctor about screening options if you are at high risk or over 74 years old.
  • Breast cancer: Patient FAQ

    Canadian Task Force on Preventive Health Care
    This resource includes frequently asked questions about breast cancer, including: Who is considered high risk? What are the harms associated with mammography? and Why is routine screening NOT recommended for women 40-49 years?
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