Table 3.
Summary of findings from lower risk of bias data (sensitivity analysis based on ERSPC trial)
| Outcome and timeframe | Study results and measurements | Absolute effect estimates | Certainty in effect estimates (quality of evidence) | Plain text summary | ||
|---|---|---|---|---|---|---|
| No screening | PSA screening | Difference (95% CI) | ||||
| Mortality and cancer incidence at 10 years* | ||||||
| All-cause mortality | IR 1.0 (95% CI 0.98 to 1.02) based on data from 162 243 patients in 1 study. Follow-up 13 years |
129/1000 men | 129/1000 men | 0 (3 fewer to 3 more) | Moderate (serious risk of bias†) | PSA screening probably has little or no effect on all-cause mortality |
| Prostate cancer mortality | IR 0.79 (0.69 to 0.91) based on data from 162 243 patients in 1 study. Follow-up 13 years |
3/1000 men | 2/1000 men | 1 fewer (1 fewer to 0) | Moderate (serious risk of bias†) | PSA screening probably has little or no effect on prostate cancer mortality |
| Incidence of prostate cancer (any stage) | IR 1.57 (1.51 to 1.62) based on data from 162 243 patients in 1 study. Follow-up 13 years |
32/1000 men | 50/1000 men | 18 more (16 to 20 more) | Moderate (serious risk of bias†) | PSA screening probably increases the detection of prostate cancer (any stage) |
| Incidence of localised prostate cancer (stages I and II) | RR 1.79 (1.68 to 1.82) based on data from 162 243 patients in 1 study. Follow-up 13 years |
19/1000 men | 33/1000 men | 14 more (13 to 16 more) | Moderate (serious risk of bias†) | PSA screening probably increases the detection of localised cancer |
| Incidence of advanced prostate cancer (stages III and IV) | RR 0.75 (0.69 to 0.82) based on data from 162 243 patients in 1 study. Follow-up 13 years |
13/1000 men | 10/1000 men | 3 fewer (4 to 2 fewer) | Moderate (serious risk of bias‡) | PSA screening probably has little effect on detection of advanced cancer |
| Quality of life | ||||||
| Quality of life | Measured by SF-6D (scale 0-1, high better) based on data from 1088 patients in 1 study | 0.76 mean | 0.75 mean | 0.01 lower (0.01 lower to 0.02 higher) | Low (risk of bias and indirectness)§. Data from surveys on a subsample of patients invited from sample of the Finnish ERSPC trial |
PSA screening may have little or no difference on quality of life |
| Complications and adverse effects (identical to results in table 2) | ||||||
IR=incidence ratio. RR=relative risk. PSA=prostate-specific antigen.
We used relative estimates of effect at the longest available follow-up time. However, we estimated the absolute effect on a 10-year time-horizon. We used as baseline risk in the non-screening arm of the CAP trial, because it provided the most contemporary estimates of risks from large sample of men representative of a general practice setting.
Risk of bias, serious: inadequate concealment of allocation during randomisation resulting in potential for selection bias; inadequate or lack of blinding of participants and personnel, resulting in potential for performance bias; some contamination.
Risk of bias, serious: inadequate concealment of allocation during randomisation resulting in potential for selection bias; inadequate or lack of blinding of participants and personnel, resulting in potential for performance bias; inadequate or lack of blinding of outcome assessors, resulting in potential for detection bias; some contamination.
Risk of bias, serious: based on cross-sectional analysis of random sample, self-reported measure of health related quality of life. Indirectness, serious: patients without prostate cancer were excluded from the screening arm (health related quality of life of patients screened with no diagnosis of prostate cancer may differ).