Prostate cancer screening--the evidence, the recommendations, and the clinical implications.

摘要

The PLCO trial reported a high contamination rate among men randomized to the no-screening group (ie, a high proportion had PSA screening performed outside of the trial) and a high rate of prior PSA testing in all enrollees. However, this does not mean that these results should be dismissed. Even though estimates of benefit would have been attenuated, PLCO should have been able to detect a signal suggesting benefit if it existed, because 20% more cancers— with lower Gleason scores—were identified among men in the screened group. In addition, longer 10-year results (based on two-thirds of the sample) also showed no benefit. Furthermore, PLCO is more applicable to the United States because the study included performance of annual screening (vs screening every 2 to 7 years in ERSPC) and use of potentially curative treatments was more consistent with US practice (about 90% compared with 80% in ERSPC).