THE IMPACT OF PROSTATE-SPECIFIC ANTIGEN SCREENING ON PROSTATE CANCER INCIDENCE AND MORTALITY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Author(s)
Yuhao Li, PhD1, Jingyun Luo, B.M.2, Shuhui Zhang, B.M.3, Yiqiao Lv, B.A.4, Luyuan Yang, B.A.4, Qiming Shen, B.A.4, Shengfeng Wang, PhD1;
1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Beijing, China, 2School of Public Health, Peking University, Beijing, China, 3School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 4School of Health Humanities, Peking University, Beijing, China
1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Beijing, China, 2School of Public Health, Peking University, Beijing, China, 3School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 4School of Health Humanities, Peking University, Beijing, China
OBJECTIVES: The efficacy of prostate-specific antigen (PSA) testing in the screening of prostate cancer remains uncertain. This study aims to provide updated estimates on mortality and cancer incidence associated with PSA screening.
METHODS: We performed a systematic review and meta-analysis of records from PubMed, EMBASE, and NHS databases. The inclusion criteria were limited to randomized controlled trials (RCTs) that compared PSA screening with usual care among males with no prior diagnosis of prostate cancer. Investigators independently screened studies, extracted data, and assessed risk of bias. Random-effects models were used to estimate pooled incidence rate ratios (IRRs) for mortality and overall cancer incidence, as well as pooled risk ratios (RRs) for stage-specific incidence.
RESULTS: Of the 3184 studies retrieved, 6 large-scale RCTs met the inclusion criteria and provided sufficient data for meta-analysis. The analysis showed that PSA screening was not associated with a significant reduction in all-cause mortality (IRR 0.98, 95% confidence interval [CI] 0.96 to 1.00) or prostate cancer-specific mortality (IRR 0.95, 95% CI 0.84 to 1.08). In contrast, the screening group showed a higher overall incidence of prostate cancer compared with the control group (IRR 1.26, 95% CI 1.04 to 1.52). This rise was attributable to an increase in the detection of localized (Stage I-II) prostate cancer (RR 1.39, 95% CI 1.11 to 1.75), whereas advanced (Stage III-IV) cancer incidence remained unaffected (RR 0.97, 95% CI 0.69 to 1.35).
CONCLUSIONS: PSA screening has substantially increased the diagnosis of early-stage prostate cancer, but it has not reduced the incidence of advanced disease, nor has it decreased all-cause or prostate cancer-specific mortality. This discrepancy underscores the critical need to refine screening strategies and develop more accurate risk assessment tools to better identify individuals who would truly benefit from early intervention, thereby optimizing clinical decision-making and resource allocation in prostate cancer management.
METHODS: We performed a systematic review and meta-analysis of records from PubMed, EMBASE, and NHS databases. The inclusion criteria were limited to randomized controlled trials (RCTs) that compared PSA screening with usual care among males with no prior diagnosis of prostate cancer. Investigators independently screened studies, extracted data, and assessed risk of bias. Random-effects models were used to estimate pooled incidence rate ratios (IRRs) for mortality and overall cancer incidence, as well as pooled risk ratios (RRs) for stage-specific incidence.
RESULTS: Of the 3184 studies retrieved, 6 large-scale RCTs met the inclusion criteria and provided sufficient data for meta-analysis. The analysis showed that PSA screening was not associated with a significant reduction in all-cause mortality (IRR 0.98, 95% confidence interval [CI] 0.96 to 1.00) or prostate cancer-specific mortality (IRR 0.95, 95% CI 0.84 to 1.08). In contrast, the screening group showed a higher overall incidence of prostate cancer compared with the control group (IRR 1.26, 95% CI 1.04 to 1.52). This rise was attributable to an increase in the detection of localized (Stage I-II) prostate cancer (RR 1.39, 95% CI 1.11 to 1.75), whereas advanced (Stage III-IV) cancer incidence remained unaffected (RR 0.97, 95% CI 0.69 to 1.35).
CONCLUSIONS: PSA screening has substantially increased the diagnosis of early-stage prostate cancer, but it has not reduced the incidence of advanced disease, nor has it decreased all-cause or prostate cancer-specific mortality. This discrepancy underscores the critical need to refine screening strategies and develop more accurate risk assessment tools to better identify individuals who would truly benefit from early intervention, thereby optimizing clinical decision-making and resource allocation in prostate cancer management.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO71
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders