title: Is prostate-specific antigen effective for population screening of prostate cancer? A systematic review.
abstract: BACKGROUND
  The effectiveness of prostate-specific antigen (PSA) for population screening has presented controversial results in large trials and prior reviews. We investigated the effectiveness of PSA population screening in a systematic review.
  
  
  METHODS
  The study was conducted using existing systematic reviews. We searched Ovid MEDLINE, Embase, Cochrane library, and the major Korean databases. The quality of the systematic reviews was assessed by two reviewers independently using AMSTAR. Randomized controlled trials were assessed using the risk of bias tool in the Cochrane group. Meta-analyses were conducted using Review Manager. The level of evidence of each outcome was assessed using GRADE.
  
  
  RESULTS
  Prostate-cancer-specific mortality was not reduced based on similar prior reviews (relative risk [RR] 0.93; 95% confidence interval [CI], 0.81-1.07, P=0.31). The detection rate of stage 1 prostate cancer was not greater, with a RR of 1.67 (95% CI, 0.95-2.94) and high heterogeneity. The detection rate of all cancer stages in the screening group was high, with a RR of 1.45 (95% CI, 1.13-1.85). No difference in all-cause mortality was observed between the screening and control groups (RR, 0.99; 95% CI, 0.98-1.01, P=0.50). Prostate-cancer-specific mortality, all-cause mortality, and diagnosis of prostate cancer at stages 3-4 showed moderate levels of evidence.
  
  
  CONCLUSIONS
  Differently from prior studies, our review included updated Norrköping data and assessed the sole effect of PSA testing for prostate cancer screening. PSA screening alone did not increase early stage prostate cancer detection and did not lower mortality.
authors.affiliation: Department of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Yoon Jae
authors.initials: YJ
authors.lastname: Lee
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Park
authors.forename: Byung Ryul
authors.initials: BR
authors.lastname: Jeon
authors.forename: Sang Moo
authors.initials: SM
authors.lastname: Lee
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Kim
authors.forename: You Kyoung
authors.initials: YK
authors.lastname: Lee
mesh_terms: D002986:Clinical Trials as Topic; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008403:Mass Screening; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality
chemical_list: D017430:Prostate-Specific Antigen
keywords: Mass screening; Meta-analysis; Mortality; Prostate specific antigen; Prostatic neoplasm; Review