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. 2016 Apr 12;11(4):e0153417.
doi: 10.1371/journal.pone.0153417. eCollection 2016.

Screening Coverage Needed to Reduce Mortality from Prostate Cancer: A Living Systematic Review

Ahmad K Rahal  1 , Robert G Badgett  1 , Richard M Hoffman  2
Affiliations

Screening Coverage Needed to Reduce Mortality from Prostate Cancer: A Living Systematic Review

Ahmad K Rahal et al. PLoS One. .

Abstract

Introduction: Screening for prostate cancer remains controversial because of conflicting results from the two major trials: The Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) screening trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC).

Objective: Meta-analyze and meta-regress the available PSA screening trials.

Methods: We performed a living systematic review and meta-regression of the reduction in prostate cancer mortality as a function of the duration of screening provided in each trial. We searched PubMed, Web of Science, the Cochrane Registry, and references lists from previous meta-analyses to identify randomized trials of PSA screening. We followed PRISMA guidelines and qualified strength of evidence with a GRADE Profile.

Results: We found 6 trials, but excluded one that also screened with trans-rectal ultrasound. We considered each ERSPC center as a separate trial. When pooling together all 11 trials we found no significant benefit from screening; however, the heterogeneity was 28.2% (95% CI: 0% to 65%). Heterogeneity was explained by variations in the duration of serial screening (I2 0%; 95% CI: 0% to 52%). When we analyzed the subgroup of trials that added more than 3 years of screening (range 3.2 to 3.8) we found a significant benefit for screening with risk ratio 0.78 (95% CI 0.65-0.94; I2 = 0%; 95% CI: 0% to 69%) and a number needed to invite for screening of 1000. We downgraded the quality of evidence to moderate due to our retrospective identification of subgroups and limited data on control group screening.

Conclusions: Adequate duration of screening reduces mortality from prostate cancer. The benefit, while small, compares favorably with screening for other cancers. Our projections are limited by the moderate quality of evidence.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparison of ability to explain trial results by varying assumptions for the duration of the coverage provided by a single PSA.
Fig 2
Fig 2. Flow diagram for included studies of this meta-analysis.
Fig 3
Fig 3. Determining the minimum duration of a screening program required to reduce death from prostate cancer.
Fig 4
Fig 4. Forest plot of trials sub-grouped by estimated duration of monitoring.
Fig 5
Fig 5. GRADE evidence profile.
See this image and copyright information in PMC

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