Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Is Prostate-Specific Antigen Effective for Population Screening of Prostate Cancer? A Systematic Review

  • Lee, Yoon Jae (Department of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Park, Ji Eun (Department of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Jeon, Byung Ryul (Department of Laboratory Medicine and Genetics, Soonchunhyang University College of Medicine) ;
  • Lee, Sang Moo (Department of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Kim, Soo Young (Department of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Lee, You Kyoung (Department of Laboratory Medicine and Genetics, Soonchunhyang University College of Medicine)
  • Published : 2013.07.01
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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 Norrk${\ddot{o}}$ping 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.

Keywords

References

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