PSA-based screening for prostate cancer. Too many adverse effects

Abstract

Has the evaluation of PSA screening for prostate cancer progressed since 2009? We examined the recent literature on the value of this test, using the standard Prescrire methodology. Five randomised trials have yielded conflicting results. One trial was too flawed to be conclusive. In two trials, the Erspc and Gothenburg studies, PSA-based screening appeared to prevent about 1 death from prostate cancer per 300 to 1400 men screened. However, two other trials, including the PLCO study that enrolled 77 000 men, showed no statistically significant benefit from screening. Two meta-analyses showed that PSA screening did not reduce mortality from prostate cancer among 340 000 and 390 000 men followed for 9 to 15 years. About 70% of men with PSA levels above 4 ng/l do not have prostate cancer. These false-positive results unnecessarily expose patients to the adverse effects of prostate biopsy, which include haematuria, pain, infections and septicaemia. Between 30% and 80% of cancers diagnosed by screening would never have compromised patients' health if they had remained undetected. This over-diagnosis unnecessarily exposes patients to the adverse effects of treatment, which include urinary incontinence, erectile dysfunction, and psychological effects. In early 2012, the clinical utility of PSA-based screening for prostate cancer has not been demonstrated. Patients should be informed of the natural history of localised prostate cancer and the adverse effects of screening.