Prostate-Specific Antigen Screening and Overdiagnosis in Prostate Cancer: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Prostate cancer is the most frequently diagnosed malignancy among men. Screening strategies aimed at reducing prostate cancer–related mortality have raised concerns about overdiagnosis—defined as the detection of cancers that would not cause symptoms or death during a patient’s lifetime—and subsequent overtreatment. This review systematically evaluates whether PSA-based screening primarily enables early detection or contributes to clinically relevant overdiagnosis. Methods: Following PRISMA guidelines, randomized controlled trials and cohort studies enrolling men aged ≥ 40 years without prior prostate cancer were included. Studies compared PSA-based screening with no screening or alternative strategies. PubMed, Web of Science, and Scopus were searched from 2015 onward. Risk of bias was assessed using RoB2 for randomized trials and the Newcastle–Ottawa Scale for cohort studies. Primary outcomes included prostate cancer diagnosis, overdiagnosis, prostate cancer–specific mortality, and overall mortality. Results: Thirteen studies enrolling men aged 45–74 years, with follow-up ranging from 2 to 22 years and sample sizes from 4,276 to 415,357, were included. Biopsy-related complications were infrequent (≤2%), and MRI-guided biopsy was associated with fewer infectious complications compared with standard transrectal biopsy. Overdiagnosis estimates varied widely across studies; however, the pooled estimate was not statistically significant (RR 1.56 [95% CI 0.65–3.79]). PSA screening did not reduce overall mortality (RR 0.99 [95% CI 0.88–1.11]). Prostate cancer–specific mortality was modestly reduced, with pooled results borderline significant (IRR 0.87 [95% CI 0.76–1.00]). Substantial heterogeneity and risk of bias across studies limited the certainty and generalizability of pooled estimates. Conclusion: PSA-based screening is associated with a modest reduction in prostate cancer–specific mortality without an improvement in overall survival. Lower overdiagnosis rates observed in more recent, risk-adapted screening strategies highlight the importance of shared decision-making and support the integration of modern diagnostic tools to minimize harms. Further well-designed, representative trials are needed to define optimal screening pathways across diverse populations
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.050 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".