Pulse Brain · Growing Health Evidence Index
Tier 2 — RCT / large cohortPeer-reviewed

Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality

Richard M. Martin, Jenny Donovan, Emma L. Turner, Chris Metcalfe, Grace Young, Eleanor Walsh, J. Athene Lane, Sian Noble, Steven Oliver, Simon Evans, Jonathan A C Sterne, Peter Holding, Yoav Ben‐Shlomo, Peter Brindle, Naomi Williams, Elizabeth Hill, Siaw Yein Ng, Jessica Toole, Marta Tazewell, Laura J. Hughes, Charlotte Davies, Joanna Thorn, Liz Down, George Davey Smith, David E. Neal, Freddie C. Hamdy, CAP Trial Group

JAMA · 2018

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Summary

The CAP trial, a large cluster-randomised controlled trial of 415,357 men aged 50–69 years across 573 UK primary care practices, evaluated whether a single PSA screening intervention reduces prostate cancer-specific mortality. After a median 10-year follow-up, the study found no significant difference in prostate cancer-specific mortality between the screened and control groups (rate ratio 0.96; 95% CI 0.85–1.08), suggesting that a single PSA screening invitation with standardised diagnostic pathways does not substantially reduce prostate cancer mortality in this population.

UK applicability

This trial was conducted across the United Kingdom and directly informs UK screening policy and primary care practice. The findings suggest that opportunistic or invitation-based PSA screening, as currently practised in UK general practice, does not provide significant mortality benefit and should be considered alongside risks of overdiagnosis and overtreatment in clinical decision-making.

Key measures

Prostate cancer-specific mortality rate per 1000 person-years; rate ratio and rate difference between intervention and control groups; Gleason grade; diagnostic stage; all-cause mortality

Outcomes reported

The study measured prostate cancer-specific mortality at median 10-year follow-up, as well as diagnostic cancer stage, Gleason grade, all-cause mortality, and the causal effect of attending PSA screening clinics.

Theme
Policy, governance & rights
Subject
Other / interdisciplinary
Study type
Research
Study design
RCT
Source type
Peer-reviewed study
Status
Published
Geography
United Kingdom
System type
Human clinical
DOI
10.1001/jama.2018.0154
Catalogue ID
BFmovi24gk-3yrplh

Topic tags

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