Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisScreening for prostate cancer may reduce death due to prostate cancer but has associated harms
Bell N, Connor Gorber S, Shane A, et al. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ. 2014;186:1225-34.
Review question
What are the benefits and harms of screening men for prostate cancer using the prostate-specific-antigen (PSA) test?
Background
Prostate cancer is one of the most commonly diagnosed cancers in men. Most prostate cancers are slow growing and not life-threatening. The PSA test and digital rectal examination are used to screen for prostate cancer. Screening can lead to detection of cancers that would not progress to cause symptoms or death. Men with positive screening tests often have further, more invasive tests, such as prostate biopsy. For men with a prostate cancer diagnosis, the survival rate is 95% at 10 years.
How the review was done
The researchers did a systematic review, searching for studies that were published up to August 2014.
They found 3 randomized controlled trials of sufficient quality, with over 200,000 men.
The trials assessed the benefits and harms of screening for prostate cancer using the PSA test in men who did not have symptoms of prostate cancer.
Screening was compared with no screening or usual care in the general population.
Men who had previous PSA tests were included.
What the researchers found (Table)
No studies included digital rectal examination, alone or with PSA screening.
Screening for prostate cancer with PSA may reduce death due to prostate cancer but it does not reduce death due to any cause.
PSA screening falsely indicates prostate cancer in some men and also detects a number of cases that would not cause symptoms or death because they are growing slowly.
Because of the errors of PSA screening, men with positive tests usually go on to have a prostate biopsy, done with a needle. Prostate biopsy can cause harms, such as blood in the urine, infection, hospital admission, and death.
Conclusions
Screening men for prostate cancer using the prostate-specific-antigen test may reduce death due to prostate cancer, but it does not reduce death due to any cause. Tests to confirm the results of positive PSA tests can have adverse effects.
Effects of prostate screening in men without symptoms
| Outcome | Effects of screening | Quality of evidence |
| Death due to prostate cancer | 2 trials found that screening reduced death due to prostate cancer 1 study found no effect | Moderate |
| Death due to any cause | Screening did not affect death from any cause | Moderate |
| Overdiagnosis | 40% to 56% of cases of prostate cancer that were detected would not progress to cause symptoms or death | Very low |
| False-positive test results | 11% to 20% of men who had positive screening tests did not have prostate cancer | Very low |
| Harms of prostate biopsy following positive screening tests | After prostate biopsy: 310 men out of 1000 had blood in the urine 9 men out of 1000 had an infection 21 men out of 1000 were hospitalized 2 men out of 1000 died | Very low |
Related Topics
Glossary
A test result that suggests the presence of a disease which turns out not to be there.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
Related Evidence Summaries
-
Educational interventions are effective in improving knowledge about cancer risk reduction among men
Patient Education and Counseling (2018) -
Automated telephone communication systems for preventive healthcare and management of long-term conditions
Cochrane Database of Systematic Reviews (2016) -
Screening for lung cancer
Cochrane Database of Systematic Reviews (2013)
Related Web Resources
-
Breast cancer: Risks and benefits, age 50-69
Canadian Task Force on Preventive Health CareYour risk of dying from breast cancer is slightly reduced if you have regular screening. However, regular screening increases your chance of a false positive result, a biopsy and having part or all of a breast removed unnecessarily. -
Breast cancer: Patient algorithm
Canadian Task Force on Preventive Health CareThe Canadian Task Force on Preventive Health Care recommends women between 50 and 74 years old who are not at high risk get screened for breast cancer every 2 to 3 years. Talk to your doctor about screening options if you are at high risk or over 74 years old. -
Breast cancer: Patient FAQ
Canadian Task Force on Preventive Health CareThis resource includes frequently asked questions about breast cancer, including: Who is considered high risk? What are the harms associated with mammography? and Why is routine screening NOT recommended for women 40-49 years?
Register for free access to all Professional content
RegisterOur Content
About
Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. .
