- Design
- Systematic review of randomised trials (abridged Cochrane update)
- Population
- 6 trials, 789,086 men without prior prostate cancer
- Primary outcome
- Prostate cancer-specific and overall mortality, screening vs no screening
- Effect
- Cancer-specific RR 0.87 (95% CI 0.80 to 0.95); overall mortality RR 0.99 (0.97 to 1.00)
An update of a 2013 Cochrane review pooled six randomised trials with 789,086 participants and follow-up from 3.2 to 23 years. Five trials tested PSA alone and one tested PSA with a kallikrein panel and MRI.
Using the European trial (ERSPC) as the main sensitivity analysis, screening likely reduced prostate cancer-specific mortality (RR 0.87, 95% CI 0.80 to 0.95; moderate certainty), roughly two fewer deaths per 1,000 men (one to three fewer). Across all eligible trials, overall mortality showed RR 0.99 (0.97 to 1.00; low certainty), about five fewer deaths per 1,000, with an interval that includes no effect. Adverse events and quality of life showed little or no difference, with low certainty.
The authors stress that interpretation depends on what counts as a minimal important difference. The combined PSA, kallikrein and MRI trial has only 3.2 years of follow-up, so mortality data are not mature. The review does not weigh overdiagnosis or overtreatment in detail, so the benefit sits beside harms that the abstract does not quantify.
- Frame the benefit as about two fewer prostate cancer deaths per 1,000 men over long follow-up.
- Overall mortality benefit is uncertain; the interval includes no effect.
- Counsel on false positives, biopsy and overdiagnosis, which this abstract does not quantify.
- MRI-based screening pathways have not yet reported mortality.
Why it matters
It gives clinicians absolute numbers for counselling rather than a relative figure that exaggerates the benefit.
Don't overread it
This review does not change screening guidelines, and overdiagnosis harms are not quantified in the abstract.
The statistics, in plain English
A relative risk of 0.87 sounds large but, with a baseline of 16 deaths per 1,000, it means about two fewer per 1,000. Whether that is worthwhile depends on how much weight a man places on avoiding biopsies and treatment he may not need.
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