Screening for prostate cancer: Can randomized studies optimize the trade-off between over - and under-diagnosis?

Objectives: The outcome from the screening trials on prostate cancer published in recent years may at a first glance seem contradictory. A review of all randomized controlled trials was undertaken in order to explore these divergences. Methods: PubMed was searched for all publications on prostate cancer screening trials. Results: Five randomized controlled trials were found. The only trial that could show a statistically significant impact on prostate cancer mortality was the European Randomized Study of Screening for Prostate Cancer (ERSPC), in particular the Gothenburg Centre, which constitutes on of eight units of the ERSPC trials. The absence of significant outcome from the other trials may, however, be explained by higher PSA threshold, longer screening intervals and shorter follow-up. Conclusions: Screening for prostate cancer may reduce prostate cancer mortality, but to the cost of over-detection and over-treatment.