Is population-based screening for prostate cancer by PSA beneficial to Hong Kong senior citizens? : a systematic review

Abstract

Background Prostate cancer was the third most common cancer among male population in Hong Kong. With prominent impact of prostate cancer, a local health agency launched a health awareness campaign in 2015. It led to the need to evaluate the pros and cons of PSA mass screening in local population. Objective To determine whether screening for prostate cancer by PSA test reduce all-cause mortality and prostate cancer specific-mortality in East Asian population aged from 50 to 69, and to assess the frequency of its related adverse effects, categorized by severity level. Methods A systematic electronic search of PubMed, EMBASE and Cochrane Library was done. Studies focusing on East Asian population were exclusively selected. The PSA sensitivity, PSA specificity, prostate cancer prevalence, prostate biopsy complication rates, all-cause mortality and prostate cancer specific-mortality in East Asian population were estimated. Results The prostate cancer prevalence was estimated as 14.6%, PSA sensitivity as 91% and PSA specificity as 36%. Significant voiding problem, infection required treatment and biopsied population. In other words, among a 100,000 PSA screened population, 12,077 of individuals would experience biopsy related complications. All-cause mortality reduction through PSA screening was 0.96 [95%CI 0.92 - 1.01] and prostate cancer specific-mortality was 0.91 [95%CI 0.59 - 1.41]; both of them were statistically insignificant. Conclusion Asian data shows no mortality reduction through PSA screening. However, the negative impacts induced by screening would be significant. By the evidence of this review, it is suggested not to exercise a mass PSA screening in Hong Kong for people aged 50-69.