Evidence of benefit of screening for prostate cancer with PSA testing
| Study (country) | Study characteristics | PSA threshold, ng/mL | Contamination (rate of screening in control group), % | Prostate cancer mortality, RR (95% CI) | All-cause mortality, RR (95% CI) | Absolute effect | GRADE quality of evidence* |
|---|---|---|---|---|---|---|---|
| PLCO21 (United States) | RCT; 76 693 men aged 55–74 yr; annual PSA screening for 6 yr and digital rectal examination annually for 4 yr; 14-yr follow-up | 4 | 52 | 1.09 (0.87–1.36) | 0.96 (0.93–1.00) | No effect | Moderate |
| ERSPC19 (Finland, Sweden, Italy, the Netherlands, Belgium, Spain and Switzerland) | RCT; 162 243 men aged 50–74 yr (core group 55–69 yr); PSA screening every 4 yr; 13-yr follow-up | 3.0 at most sites | 20 | Core group: 0.79 (0.69–0.91) All ages: 0.83 (0.73–0.94) | Core group: 1.00 (0.98–1.02) All ages: 1.00 (0.98–1.02) | 12.8 fewer deaths per 10 000 men screened | Moderate |
Note: CI = confidence interval, ERSPC = European Randomized Study of Screening for Prostate Cancer, PLCO = Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, PSA = prostate-specific antigen, RCT = randomized controlled trial, RR = relative risk.
↵* GRADE (Grading of Recommendations, Assessment, Development and Evaluation)15 rates the continuum of quality of evidence in 4 categories of high, moderate, low or very low; see evidence review for complete assessment of study quality.13