Evid Based Med 16:20-21 doi:10.1136/ebm1165
  • Diagnosis
  • Systematic review

Meta-analysis finds screening for prostate cancer with PSA does not reduce prostate cancer–related or all-cause mortality but results likely due to heterogeneity – the two highest quality studies identified do find prostate cancer–related mortality reductions

  1. Jonas Hugosson2
  1. 1Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
  2. 2Department of Urology, Institute of clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Monique J Roobol
    Erasmus University Medical Center, Rotterdam, The Netherlands; m.roobol{at}

Commentary on:

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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