Level 2: Mid-level evidence
In two recent randomized trials, prostate cancer screening did not appear to show clinically significant benefits. The large European Randomized Study of Screening for Prostate Cancer (ERSPC) evaluated prostate-specific antigen (PSA) testing in 182,000 men with median follow-up of nine years (N Engl J Med. 2009;360:1320-1328; available at content.nejm.org/cgi/content/full/360/13/1320, accessed May 12, 2009). In a predefined core subgroup of 162,243 patients aged 55-69 years, patients screened with PSA had higher cumulative incidence of prostate cancer compared with controls (8.2% vs. 4.8%). However, the higher detection rate was not associated with a reduction in overall mortality. Screening was associated with a modest decrease in prostate cancer death (3.5 vs. 4.1 per 10,000 person-years, P =.04).  For men aged 55-69 years, the number needed to screen to prevent one prostate cancer death was 1,410 for nine years. In the Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial, annual screening was compared with usual care in 76,693 men aged 55-74 years (N Engl J Med. 2009;360:1310-1319; available at content.nejm.org/cgi/content/full/360/13/1310, accessed May 12, 2009). After seven years, the incidence of prostate cancer was again higher in the screening group (7.4% vs. 6%, P <.05), and there was no difference in overall mortality (6.7% vs. 6.8%). There was also no significant difference in prostate cancer-related deaths (2 vs. 1.7 per 10,000 person-years). The study’s authors support the recent U.S. Preventive Services Task Force statement on PSA screening (Ann Intern Med. 2008;149:185-191; available at www.annals.org/cgi/reprint/149/3/185.pdf; accessed May 12, 2009).