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Screening for prostate cancer is controversial. Although screening with prostate-specific antigen (PSA) may identify cancer at an early stage, questions remain regarding the impact of screening on mortality and other important clinical outcomes.
Djulbegovic and colleagues performed a systematic review and meta-analysis of randomised controlled trials comparing PSA-based screening with or without digital rectal examination versus no screening including nearly 400 000 asymptomatic men. Six trials met the eligibility criteria and were included in analyses on overall and disease-specific mortality and, if possible, in an analysis on clinical stage at the time of diagnosis.
The authors found that screening was associated with an increased probability of receiving a diagnosis of prostate cancer (RR 1.46, 95% CI 1.21 to 1.77, p<0.001) and stage I prostate cancer (RR 1.95, 95% CI 1.22 to 3.13, p=0.005). There was no significant effect of screening on death from prostate cancer (RR 0.88, 0.71 to 1.09, p=0.25) or overall mortality (RR 0.99, 0.97 to 1.01, p=0.44), and all trials included …
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