Oregon Health & Science University, Portland, Oregon.Agency for Healthcare Research and Quality, Rockville, Maryland; the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Stamford Hospital Center for Integrative Medicine and Wellness, Stamford, Connecticut; and Georgetown University School of Medicine, Washington, DC.
Screening can detect prostate cancer in earlier, asymptomatic stages when treatments might be more effective.
To update the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatments for prostate cancer.
Data Sources: MEDLINE (2002 to July 2011) and the Cochrane Library Database (through second quarter of 2011).
Study Selection: Randomized trials of prostate-specific antigen-based screening, randomized trials and cohort studies of prostatectomy or radiation therapy versus watchful waiting, and large observational studies of perioperative harms.
Investigators abstracted and checked study details and quality using predefined criteria.
Of 5 screening trials, the 2 largest and highest-quality studies reported conflicting results. One found screening was associated with reduced prostate cancer-specific mortality compared with no screening in a subgroup of men age 55 to 69 years after 9 years (relative risk, 0.80 [95% CI, 0.65 to 0.98]; absolute risk reduction, 0.07 percentage point). The other found no statistically significant effect after 10 years (relative risk, 1.1 [CI, 0.80 to 1.5]). After 3 or 4 screening rounds, 12% to 13% of screened men had false-positive results. Serious infections or urinary retention occurred after 0.5% to 1.0% of prostate biopsies. There were 3 randomized trials and 23 cohort studies of treatments. One good-quality trial found that prostatectomy for localized prostate cancer decreased risk for prostate cancer-specific mortality compared with watchful waiting through 13 years of follow-up (relative risk, 0.62 [CI, 0.44 to 0.87]; absolute risk reduction, 6.1%). Benefits appeared limited to men younger than 65 years of age. Treating approximately 3 men with prostatectomy or 7 men with radiation therapy instead of watchful waiting would each result in 1 additional case of erectile dysfunction. Treating approximately 5 men with prostatectomy would result in 1 additional case of urinary incontinence. Prostatectomy was associated with perioperative death (about 0.5%) and cardiovascular events (0.6% to 3%), and radiation therapy was associated with bowel dysfunction.
Only English-language articles were included. Few studies evaluated newer therapies.
Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.
Chou R, Croswell JM, Dana T, Bougatsos C, Blazina I, Fu R, Gleitsmann K, Koenig HC, Lam C, Maltz A, Rugge JB, Lin K. Are you the author?
Reference: Ann Intern Med. 2011 Oct 7. Epub ahead of print.