Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials.
OBJECTIVE
To examine the evidence on the benefits and harms of screening for prostate cancer.


METHODS
Systematic review and meta-analysis of randomised controlled trials.


METHODS
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.
Djulbegovic
Mia
M
Department of Urology and Prostate Disease Center, University of Florida, College of Medicine, PO Box 100247, Gainesville, Florida 32610-0247, USA.
Beyth
Rebecca J
RJ
Neuberger
Molly M
MM
Stoffs
Taryn L
TL
Vieweg
Johannes
J
Djulbegovic
Benjamin
B
Dahm
Philipp
P
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D051517:Digital Rectal Examination; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic