gms | German Medical Science

Objective: Although prostate-specific antigen (PSA) screening is conducted worldwide, its effectiveness in reducing mortality from prostate cancer has remained controversial. In 2009, intermediate results from the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial were released. However, the results of the two studies were inconsistent. We investigated the assessment of the two RCT results in guidelines, evidence reports and statements.

Methods: A search was performed from March 2009 to December 2011 using MEDLINE, the G-I-N library, and the National Guidelines Clearinghouse to identify guidelines, evidence reports and statements that have evaluated the two RCTs. Additional reports recommended by experts were also included as needed. The changes in the revised guidelines, evidence reports and statements were compared.

Results: Six guidelines, two evidence reports and one statement matching our criteria were identified. Although most guidelines contained no change in basic recommendations for PSA screening, the USPTSF recommended against PSA screening for all age group.

Discussion: For the introduction of population-based screening, valid evidence is required based on long follow-up studies and the balance between benefits and harms should be considered. Most US reports pointed out the necessity of shared decision-making for PSA screening in clinical settings.

Implication for guideline developers: Even after the releases of two RCTs results, most reports have not revised their assessment of PSA screening. The effect of PSA screening is still controversial, and shared decision making is needed because the potential harms cannot be ignored.