While prostate cancer (PCa) incidence and mortality rates continue to rise, early detection of PCa remains highly controversial, and the research landscape is rapidly evolving. Existing systematic reviews (SRs) and meta-analyses (MAs) provide valuable insights, but often focus on single aspects of early detection, hindering a comprehensive understanding of the topic. We aim to fill this gap by providing a comprehensive SR of contemporary SRs covering different aspects of early detection of PCa in the European Union (EU) and the UK.
On June 1, 2023, we searched four databases (Medline ALL via Ovid, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) and Google Scholar. To avoid repetition of previous studies, only SRs (qualitative, quantitative, and/or MAs) were considered eligible. In the data, common themes were identified to present the evidence systematically.
We identified 1358 citations, resulting in 26 SRs eligible for inclusion. Six themes were identified: (1) invitation: men at general risk should be invited at >50 yr of age, and testing should be discontinued at >70 yr or with <10 yr of life expectancy; (2) decision-making: most health authorities discourage population-based screening and instead recommend a shared decision-making (SDM) approach, but implementation of SDM in clinical practice varies widely; decision aids help men make more informed and value-consistent screening decisions and decrease men's intention to attempt screening, but these do not affect screening uptake; (3) acceptance: facilitators for men considering screening include social prompting by partners and clinician recommendations, while barriers include a lack of knowledge, low-risk perception, and masculinity attributes; (4) screening test and algorithm: prostate-specific antigen-based screening reduces PCa-specific mortality and metastatic disease in men aged 55-69 yr at randomisation if screened at least twice; (5) harms and benefits: these benefits come at the cost of unnecessary biopsies, overdiagnosis, and subsequent overtreatment; and (6) future of screening: risk-adapted screening including (prebiopsy) risk calculators, magnetic resonance imaging, and blood- and urine-based biomarkers could reduce these harms. To enable a comprehensive overview, we focused on SRs. These do not include the most recent prospective studies, which were therefore incorporated in the discussion.
By identifying consistent and conflicting evidence, this review highlights the evidence-based foundations that can be built upon, as well as areas requiring further research and improvement to reduce the burden of PCa in the EU and UK.
This review of 26 reviews covers various aspects of prostate cancer screening such as invitation, decision-making, screening tests, harms, and benefits. This review provides insights into existing evidence, highlighting the areas of consensus and discrepancies, to guide future research and improve prostate cancer screening strategies in Europe.
European urology. 2024 Aug 24 [Epub ahead of print]
Renée C A Leenen, Lionne D F Venderbos, Jozien Helleman, Juan Gómez Rivas, Pieter Vynckier, Lieven Annemans, Renata Chloupková, Ondřej Májek, Erik Briers, Vera Vasilyeva, Sebastiaan Remmers, Meike J van Harten, Frederique B Denijs, Ivo I de Vos, Arunah Chandran, Partha Basu, Roderick C N van den Bergh, Sarah Collen, Hein Van Poppel, Monique J Roobol, Katharina Beyer, PRAISE-U Consortium
Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands. Electronic address: ., Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands., Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain., Department of Public Health and Primary Care, Ghent University, Ghent, Belgium., National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia., Europa Uomo, Antwerp, Belgium., European Association of Urology, Policy Office, Arnhem, The Netherlands., International Agency for Research on Cancer/World Health Organization, Lyon, France., European Association of Urology, Policy Office, Arnhem, The Netherlands; Department of Urology, KU Leuven, Leuven, Belgium.