Summary
The CAP trial, a large UK-based cluster randomized controlled trial of 415,357 men aged 50–69, found that a single PSA screening intervention with standardized diagnostic pathway resulted in no significant difference in prostate cancer-specific mortality compared to standard practice at 10-year follow-up (rate ratio 0.96; 95% CI 0.85–1.08). Although 40% of the intervention group attended screening and 36% underwent PSA testing, with 85% of those with elevated PSA undergoing biopsy, these efforts did not translate into a measurable mortality benefit, informing the ongoing debate about the net benefits and harms of prostate cancer screening.
UK applicability
As a primary UK study conducted across 573 NHS general practices, the findings directly inform UK screening policy and clinical practice. The results suggest that single-occasion PSA screening with systematic follow-up in primary care does not confer prostate cancer mortality reduction in this population, relevant to UK National Screening Committee guidance on prostate cancer screening.
Key measures
Prostate cancer-specific mortality (per 1000 person-years); rate ratio and rate difference at 10-year follow-up; PSA attendance and testing uptake; biopsy rates among those with PSA 3–19.9 ng/mL; diagnostic stage and Gleason grade distribution
Outcomes reported
The study measured prostate cancer-specific mortality at a median 10-year follow-up in men aged 50–69 years invited to PSA screening versus standard practice. Secondary outcomes included diagnostic cancer stage, Gleason grade, all-cause mortality, and causal effects of attending screening.
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