In two recent randomized trials, prostate cancer screening did not appear to show clinically significant benefits. A large European trial (ERSPC trial) evaluated prostate-specific-antigen (PSA) testing in 182,000 men with median follow-up of 9 years. There was a predefined core subgroup of 162,243 patients aged 55-69 years. In this subgroup, the patients screened with PSA had higher cumulative incidence of prostate cancer compared to controls (8.2% vs. 4.8%). However, the higher detection rate was not associated with a reduction in overall mortality (level 2 [mid-level] evidence). There was a modest decrease in prostate cancer death associated with screening (3.5 vs. 4.1 per 10,000 person-years, p = 0.04). For men aged 55-69 years, the number needed to screen to prevent 1 prostate cancer death was 1,410 for 9 years (N Engl J Med 2009 Mar 26;360(13):1310). In a second trial in the United States (PLCO trial), annual screening was compared to usual care in 76,693 men aged 55-74 years. After 7 years, the incidence of prostate cancer was again higher in the screening group (7.4% vs. 6%, p < 0.05), and there was no difference in overall mortality (6.7% vs. 6.8%) (level 2 [mid-level] evidence). There was also no significant difference in prostate cancer-related death (2 vs. 1.7 deaths per 10,000 person-years) (N Engl J Med 2009 Mar 26;360(13):1310). The authors support the recent USPSTF statement on PSA screening (DynaMed Weekly Update 33). For more information, see the Prostate cancer topic in DynaMed.
