title: Screening Coverage Needed to Reduce Mortality from Prostate Cancer: A Living Systematic Review.
abstract: BACKGROUND
  Screening for prostate cancer remains controversial because of conflicting results from the two major trials: The Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) screening trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC).
  
  
  OBJECTIVE
  Meta-analyze and meta-regress the available PSA screening trials.
  
  
  METHODS
  We performed a living systematic review and meta-regression of the reduction in prostate cancer mortality as a function of the duration of screening provided in each trial. We searched PubMed, Web of Science, the Cochrane Registry, and references lists from previous meta-analyses to identify randomized trials of PSA screening. We followed PRISMA guidelines and qualified strength of evidence with a GRADE Profile.
  
  
  RESULTS
  We found 6 trials, but excluded one that also screened with trans-rectal ultrasound. We considered each ERSPC center as a separate trial. When pooling together all 11 trials we found no significant benefit from screening; however, the heterogeneity was 28.2% (95% CI: 0% to 65%). Heterogeneity was explained by variations in the duration of serial screening (I2 0%; 95% CI: 0% to 52%). When we analyzed the subgroup of trials that added more than 3 years of screening (range 3.2 to 3.8) we found a significant benefit for screening with risk ratio 0.78 (95% CI 0.65-0.94; I2 = 0%; 95% CI: 0% to 69%) and a number needed to invite for screening of 1000. We downgraded the quality of evidence to moderate due to our retrospective identification of subgroups and limited data on control group screening.
  
  
  CONCLUSIONS
  Adequate duration of screening reduces mortality from prostate cancer. The benefit, while small, compares favorably with screening for other cancers. Our projections are limited by the moderate quality of evidence.
authors.affiliation: Department of Internal Medicine, Kansas University School of Medicine, Wichita, Kansas, United States of America.
authors.forename: Ahmad K
authors.identifier: http://orcid.org/0000-0003-2122-3396
authors.initials: AK
authors.lastname: Rahal
authors.affiliation: Department of Internal Medicine, Kansas University School of Medicine, Wichita, Kansas, United States of America.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Badgett
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
mesh_terms: D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality*