title: Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force.
abstract: BACKGROUND
  Screening can detect prostate cancer at earlier, asymptomatic stages, when treatments might be more effective.
  
  
  OBJECTIVE
  To update the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatments for prostate cancer.
  
  
  METHODS
  MEDLINE (2002 to July 2011) and the Cochrane Library Database (through second quarter of 2011).
  
  
  METHODS
  Randomized trials of prostate-specific antigen-based screening, randomized trials and cohort studies of prostatectomy or radiation therapy versus watchful waiting, and large observational studies of perioperative harms.
  
  
  METHODS
  Investigators abstracted and checked study details and quality using predefined criteria.
  
  
  RESULTS
  Of 5 screening trials, the 2 largest and highest-quality studies reported conflicting results. One found that screening was associated with reduced prostate cancer-specific mortality compared with no screening in a subgroup of men aged 55 to 69 years after 9 years (relative risk, 0.80 [95% CI, 0.65 to 0.98]; absolute risk reduction, 0.07 percentage point). The other found no statistically significant effect after 10 years (relative risk, 1.1 [CI, 0.80 to 1.5]). After 3 or 4 screening rounds, 12% to 13% of screened men had false-positive results. Serious infections or urine retention occurred after 0.5% to 1.0% of prostate biopsies. There were 3 randomized trials and 23 cohort studies of treatments. One good-quality trial found that prostatectomy for localized prostate cancer decreased risk for prostate cancer-specific mortality compared with watchful waiting through 13 years of follow-up (relative risk, 0.62 [CI, 0.44 to 0.87]; absolute risk reduction, 6.1%). Benefits seemed to be limited to men younger than 65 years. Treating approximately 3 men with prostatectomy or 7 men with radiation therapy instead of watchful waiting would each result in 1 additional case of erectile dysfunction. Treating approximately 5 men with prostatectomy would result in 1 additional case of urinary incontinence. Prostatectomy was associated with perioperative death (about 0.5%) and cardiovascular events (0.6% to 3%), and radiation therapy was associated with bowel dysfunction.
  
  
  CONCLUSIONS
  Only English-language articles were included. Few studies evaluated newer therapies.
  
  
  CONCLUSIONS
  Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors: Oregon Health & Science University, Portland, Oregon 97239, USA. chour@ohsu.edu
authors: Roger
authors: R
authors: Chou
authors: Jennifer M
authors: JM
authors: Croswell
authors: Tracy
authors: T
authors: Dana
authors: Christina
authors: C
authors: Bougatsos
authors: Ian
authors: I
authors: Blazina
authors: Rongwei
authors: R
authors: Fu
authors: Ken
authors: K
authors: Gleitsmann
authors: Helen C
authors: HC
authors: Koenig
authors: Clarence
authors: C
authors: Lam
authors: Ashley
authors: A
authors: Maltz
authors: J Bruin
authors: JB
authors: Rugge
authors: Kenneth
authors: K
authors: Lin
mesh_terms: D001706:Biopsy / Q000009:adverse effects; D007172:Erectile Dysfunction / Q000209:etiology; D019317:Evidence-Based Medicine; D005189:False Positive Reactions; D006801:Humans; D008297:Male; D008403:Mass Screening; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen