Summary
This large UK cluster randomised trial of 415,357 men aged 50–69 found that a single PSA screening intervention with standardised diagnostic pathway did not significantly reduce prostate cancer-specific mortality over 10 years compared with standard practice. Whilst 40% of the intervention group attended screening and 36% underwent PSA testing, the rate of prostate cancer death was nearly identical between groups (0.30 vs 0.31 per 1000 person-years; RR 0.96, 95% CI 0.85–1.08), suggesting that one-off PSA screening offers minimal mortality benefit despite detecting cancers at earlier stages in some men.
UK applicability
These findings are directly applicable to UK prostate cancer screening policy and primary care practice, having been conducted across 573 UK practices. The results inform ongoing debates within the NHS regarding opportunistic PSA screening, suggesting that single-episode screening invitations do not justify widespread implementation as a mortality reduction strategy.
Key measures
Prostate cancer-specific mortality (per 1000 person-years); rate ratio and rate difference; diagnostic stage and Gleason grade of detected cancers; PSA test uptake and biopsy rates; all-cause mortality
Outcomes reported
The study measured prostate cancer-specific mortality at median 10-year follow-up, comparing men invited to PSA screening versus standard unscreened practice. Secondary outcomes included diagnostic cancer stage, Gleason grade, all-cause mortality, and causal effects of screening attendance.
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