Commentary

prostate-specific antigen (PSA)–based screening reduce risk for prostate cancer mortality or all-cause mortality? What are the harms? Review scope Included studies evaluated PSA-based screening for prostate can-cer in asymptomatic men. Studies of treatment in clinically local-ized prostate cancer were also considered, but these results are not reported in this abstract. Outcomes were all-cause mortality, prostate cancer mortality, and screening-related harms. Review methods MEDLINE (2002 to Jul 2011), Cochrane Library (2011, Issue 2), and reference lists were searched for English-language, ran-domized controlled trials (RCTs). 5 RCTs (n = 9026 to 182 160, age 45 to 80 y, median follow-up 6.3 to 14 y) met inclusion crite-ria; 1 site from a multisite RCT reported additional data sepa-rately. Data were not pooled. Main results PSA-based screening did not reduce prostate cancer mortality or all-cause mortality in any RCT (Table). In a subgroup analysis from a multisite RCT and from a single site in the same RCT, PSA-based screening reduced prostate cancer mortality in men < 70 years of age (Table). 1 in 8 screened participants had false-positive results after 3 to 4 PSA tests in 2 RCTs, and 5.5 % of those with false-positive results had ≥ 1 biopsy in 1 RCT (Table). Conclusion Prostate-specific antigen–based screening does not reduce risk for prostate cancer mortality or all-cause mortality