Comparative Effectiveness Analysis of Different Prostate Cancer Screening Strategies: A Systematic Review and Meta-Analysis

<ns3:p>Objectives International guidelines for prostate cancer screening vary, reflecting differences in healthcare systems, population risk profiles, and clinical practice preferences. A key difference among existing prostate cancer screening strategies is the frequency of screening; however, direct comparative evidence between different screening schemes remains limited. This study aimed to compare the effects of various prostate cancer screening intervals on clinical outcomes. Methods This systematic review and meta-analysis included major randomized controlled trials comparing prostate cancer screening methods with no screening. A meta-analysis was conducted to synthesize clinical evidence across various screening strategies. Sensitivity analyses were performed to assess the robustness of findings based on study quality. (PROSPERO ID: CRD42021265092), Results Seven studies evaluating four main prostate cancer screening strategies were included in the meta-analysis. These strategies were categorized into four groups: 1) Two-year screening (e.g., Göteborg), 2) Four-year screening (e.g., ERSPC, Finnish), 3) Short-term screening (e.g., PLCO, Norrköping), and 4) One-time screening (e.g., CAP, Stockholm). In terms of prostate cancer detection, two-year interval screening showed the highest detection rate (RR = 1.88; 95% CI: 1.74–2.02), followed by four-year interval screening (RR = 1.42; 95% CI: 1.26–1.59). The overall analysis showed a significant increase in detection across all strategies (RR = 1.49; 95% CI 1.37–1.62). For prostate cancer-specific mortality, significant reductions were observed with two-year (RR = 0.54; 95% CI: 0.40–0.75) and four-year screening intervals (RR = 0.75; 95% CI: 0.63–0.90). Short-term and one-time screening strategies showed no statistically significant effect yielding an RR of 0.86 (95% CI: 0.73–1.02). Conclusion Based on the meta-analysis results, PSA screening conducted every two to four years appears to offer greater benefits, as both strategies significantly increase prostate cancer detection rates and reduce prostate cancer-related mortality. These findings may support decision making in countries where the optimal PSA screening strategy remains unclear. However, other factors such as targeted age range, cost effective and budget impact analysis should also be considered in the policy decision process.</ns3:p>