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Screening for prostate cancer: systematic review
and meta-analysis of randomised controlled trials

Texte complet : BMJ 2010; 341:c4543
Mia Djulbegovic, student1, Rebecca J Beyth, associate professor2, Molly M Neuberger, research assistant1, Taryn L Stoffs, research assistant1, Johannes Vieweg, professor and chairman1, Benjamin Djulbegovic, professor3, Philipp Dahm, associate professor1 + Author Affiliations
1Department of Urology and Prostate Disease Center, University of Florida, College of Medicine, PO Box 100247, Gainesville, Florida 32610-0247, USA 2Department of Medicine, University of Florida, College of Medicine, PO Box 100277, Gainesville, Florida 3Center and Division for Evidence Based Medicine and Outcomes Research, University of South Florida, MDC 27, Tampa, Florida 33612 Correspondence to: P Dahm p.dahm@urology.ufl.edu Accepted 10 August 2010

Ces résultats montrent que le dépistage (PAS + toucher rectal) augmente les diagnostics au stade précoce, mais que cela ne se traduit par aucun bénéfice en terme de survie spécifique ni globale.
Les auteurs de la revue considèrent que cette méta-analyse peut servir à la mise à jour de certaines recommandations qui continuent, en dépit de l'absence de preuve, à promouvoir le dépistage systématique en routine.
L'organisation des dépistages systématiques doit être fondée sur des essais randomisés attestant de l'impact positif de ces dépistages. Ces preuves manquent pour l'instant pour recommander le dépistage systématique du cancer de la prostate.
Au niveau individuel chaque patient doit pouvoir choisir, en toute connaissance de cause, et cela nécessite une information claire sur les incertitudes qui restent attachées au dépistage.

Voir également :
----- Screening for prostate cancer PSA testing should be tailored to individual risk [Lire] (BMJ 2010)
----- Analyse critique des articles issus des études ERSPC et PLCO publiés en mars 2009 [Lire] (HAS 2009)

Abstract

Objective To examine the evidence on the benefits and harms of screening for prostate cancer. Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Electronic databases including Medline, Embase, CENTRAL, abstract proceedings, and reference lists up to July 2010.

Review methods
Included studies were randomised controlled trials comparing screening by prostate specific antigen with or without digital rectal examination versus no screening. Data abstraction and assessment of methodological quality with the GRADE approach was assessed by two independent reviewers and verified by the primary investigator. Mantel-Haenszel and inverse variance estimates were calculated and pooled under a random effects model expressing data as relative risks and 95% confidence intervals.

Results Six randomised controlled trials with a total of 387?286 participants that met inclusion criteria were analysed. Screening was associated with an increased probability of receiving a diagnosis of prostate cancer (relative risk 1.46, 95% confidence interval 1.21 to 1.77; P<0.001) and stage I prostate cancer (1.95, 1.22 to 3.13; P=0.005). There was no significant effect of screening on death from prostate cancer (0.88, 0.71 to 1.09; P=0.25) or overall mortality (0.99, 0.97 to 1.01; P=0.44). All trials had one or more substantial methodological limitations. None provided data on the effects of screening on participants’ quality of life. Little information was provided about potential harms associated with screening.

Conclusions The existing evidence from randomised controlled trials does not support the routine use of screening for prostate cancer with prostate specific antigen with or without digital rectal examination
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