Cochrane updates prostate cancer screening review

Cochrane has updated its 2013 prostate cancer screening review, finding that PSA-based screening likely reduces prostate cancer-specific mortality. The review was published May 15 in the Cochrane Database of Systematic Reviews.

Reviewers analyzed 6 randomized trials involving 789,086 men in Canada, Europe, and the U.S. Participants were ages 45 to 80 and were followed for 3.2 to 23 years.

PSA testing likely reduced prostate cancer deaths over 23 years of follow-up, with 2 fewer deaths per 1,000 men screened, according to Cochrane. The mortality finding came from 1 study involving 162,241 men.

Screening also increased prostate cancer diagnoses. Cochrane reported 36 more prostate cancers and 34 more localized cancers per 1,000 men screened, while metastatic cancer diagnoses may have been reduced by 5 per 1,000 men screened.

Evidence on harms remained limited. Cochrane said the reviewed studies did not provide evidence on biopsy-related complications or treatment-related complications such as urinary, erectile, or bowel problems.

A newer screening strategy was assessed in 1 study involving 60,745 men. That approach combined PSA testing with a kallikrein panel and prostate imaging before biopsy.

Cochrane said the combined strategy likely finds more prostate cancers, but it remains unclear whether it reduces deaths from prostate cancer or any cause. The study did not report mortality outcomes.

The authors concluded that emerging alternatives such as kallikrein panel and MRI-based screening may have little to no effect on prostate cancer diagnoses, with mortality results not yet known.