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 randomized controlled trial of 415,357 men aged 50–69 across 573 United Kingdom primary care practices, evaluated whether a single PSA screening invitation and standardized diagnostic pathway reduced prostate cancer-specific mortality over 10 years. The intervention resulted in 40% clinic attendance and 36% PSA testing uptake, but showed no significant mortality benefit: 549 prostate cancer deaths (0.30 per 1000 person-years) in the screened group versus 647 deaths (0.31 per 1000 person-years) in the control group (rate ratio 0.96; 95% CI, 0.85–1.08; P=0.50). These findings contribute to the evidence base on the efficacy and harms of opportunistic prostate cancer screening in primary care settings.

Regional applicability

This study was conducted in the United Kingdom across NHS primary care practices and directly reflects UK healthcare settings and screening policy context. The findings are directly applicable to United Kingdom prostate cancer screening programmes and inform current guidance on PSA testing in primary care.

Key measures

Prostate cancer-specific mortality rate per 1000 person-years; rate ratio; rate difference; PSA testing uptake; diagnostic stage and Gleason grade distribution; all-cause mortality

Outcomes reported

The study measured prostate cancer-specific mortality at median 10-year follow-up, comparing a single PSA screening intervention with standardized diagnostic pathway against standard unscreened practice. Secondary outcomes included diagnostic cancer stage, Gleason grade, and all-cause mortality.

Theme
General food systems / other
Subject
Other / interdisciplinary
Study type
Research
Study design
RCT (cluster randomized trial)
Source type
Peer-reviewed study
Status
Published
Geography
United Kingdom
System type
Human clinical
DOI
10.1001/jama.2018.0154
Catalogue ID
BFmowc2by2-bhqpkp

Topic tags

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