Randomized trial results did not resolve controversies surrounding prostate cancer screening

Abstract

Purpose of review: Prostate cancer screening remains controversial. This review will address recently published results from randomized controlled screening trials as well as current practice guidelines.

Recent findings: The Prostate Lung Colorectal and Ovarian Cancer Screening Trial found that screening did not decrease prostate cancer mortality after 7 years of follow-up. High-screening rates in the control group, the low number of deaths from prostate cancer, and the relatively short follow-up duration contributed to the negative results. The European Randomized Study of Screening for Prostate Cancer found that screening reduced prostate cancer mortality by 20% during a median 9 years of follow-up. However, the absolute benefit (0.7/1000 reduction) was small and was associated with a 70% increase in prostate cancer diagnosis. Subsequently, the American Urological Association recommended beginning screening at the age of 40 years and not relying on a specific prostate-specific antigen cutoff for biopsy referral. The United States Preventive Services Task Force and American Cancer Society have yet to issue updated guidelines.

Summary: The randomized trials suggest that screening at best will have a small survival benefit but substantial potential risk for overdiagnosis and overtreatment. Patients need to understand these tradeoffs in order to make informed decisions about screening.