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Meta-Analysis
. 2010 Sep 14:341:c4543.
doi: 10.1136/bmj.c4543.

Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials

Mia Djulbegovic  1 , Rebecca J Beyth, Molly M Neuberger, Taryn L Stoffs, Johannes Vieweg, Benjamin Djulbegovic, Philipp Dahm
Affiliations
Meta-Analysis

Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials

Mia Djulbegovic et al. BMJ. .

Abstract

Objective: To examine the evidence on the benefits and harms of screening for prostate cancer.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: Electronic databases including Medline, Embase, CENTRAL, abstract proceedings, and reference lists up to July 2010. Review methods Included studies were randomised controlled trials comparing screening by prostate specific antigen with or without digital rectal examination versus no screening. Data abstraction and assessment of methodological quality with the GRADE approach was assessed by two independent reviewers and verified by the primary investigator. Mantel-Haenszel and inverse variance estimates were calculated and pooled under a random effects model expressing data as relative risks and 95% confidence intervals.

Results: Six randomised controlled trials with a total of 387 286 participants that met inclusion criteria were analysed. Screening was associated with an increased probability of receiving a diagnosis of prostate cancer (relative risk 1.46, 95% confidence interval 1.21 to 1.77; P<0.001) and stage I prostate cancer (1.95, 1.22 to 3.13; P=0.005). There was no significant effect of screening on death from prostate cancer (0.88, 0.71 to 1.09; P=0.25) or overall mortality (0.99, 0.97 to 1.01; P=0.44). All trials had one or more substantial methodological limitations. None provided data on the effects of screening on participants' quality of life. Little information was provided about potential harms associated with screening.

Conclusions: The existing evidence from randomised controlled trials does not support the routine use of screening for prostate cancer with prostate specific antigen with or without digital rectal examination.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any institution for the submitted work; no financial relationships with any institutions that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Search strategy to identify trials of screening for prostate cancer
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Fig 2 Effects of screening on all cause mortality and death from prostate cancer
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Fig 3 Effects of screening on diagnosis of prostate cancer
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Fig 4 Effects of screening on prostate cancer stage at time of diagnosis
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