Screening: Five RCTs were included, of which two were rated fair quality and three poor quality. Sample sizes ranged from 9,026 to 182,160 participants. Maximum follow-up ranged from 11 to 20 years (median six to 14 years). Of the two fair quality trials, one (182,160 participants) found a significant decrease in prostate cancer mortality with screening in a prespecified core subgroup, but no significant difference overall (nine year median follow-up). The other fair quality trial (76,693 participants) reported no significant difference in prostate cancer or all-cause mortality at seven or 10 years of follow-up. Three poor quality trials found no differences in prostate cancer or overall mortality. Based on two RCTs, 12 to 13% of screened men had false-positive results after three or four screening rounds. Results for other adverse events were reported.
Treatment: Three RCTs (891 participants) and 23 cohort studies (sample sizes ranging from 316 to 30,857) were included. Follow-up in included studies ranged from one to 23 years. One good quality RCT reported a significantly decreased risk of prostate cancer mortality with prostatectomy compared with watchful waiting after 13 years of follow-up (relative risk 0.62, 95% confidence interval 0.44 to 0.87). This benefit seemed to be limited to men aged younger than 65 years. A small, poor quality RCT found no difference between prostatectomy and no prostatectomy for overall survival. The third RCT did not report mortality. Eight cohort studies consistently found prostatectomy to be associated with decreased risk for prostate cancer mortality and overall mortality.
No RCTs compared radiation therapy with watchful waiting. Five cohort studies consistently found radiation therapy to be associated with decreased risk for prostate cancer mortality and overall mortality.
Results were reported for urinary incontinence, erectile dysfunction, surgical complications, effects on quality of life, and other adverse effects of treatment compared with watchful waiting.