title: Screening and prostate-cancer mortality in a randomized European study.
abstract: BACKGROUND
  The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific-antigen (PSA) testing on death rates from prostate cancer.
  
  
  METHODS
  We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006.
  
  
  RESULTS
  In the screening group, 82% of men accepted at least one offer of screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P=0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The analysis of men who were actually screened during the first round (excluding subjects with noncompliance) provided a rate ratio for death from prostate cancer of 0.73 (95% CI, 0.56 to 0.90).
  
  
  CONCLUSIONS
  PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. (Current Controlled Trials number, ISRCTN49127736.)
authors.affiliation: Department of Urology , Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.forename: Teuvo L J
authors.initials: TL
authors.lastname: Tammela
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciatto
authors.forename: Vera
authors.initials: V
authors.lastname: Nelen
authors.forename: Maciej
authors.initials: M
authors.lastname: Kwiatkowski
authors.forename: Marcos
authors.initials: M
authors.lastname: Lujan
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Denis
authors.forename: Franz
authors.initials: F
authors.lastname: Recker
authors.forename: Antonio
authors.initials: A
authors.lastname: Berenguer
authors.forename: Liisa
authors.initials: L
authors.lastname: Määttänen
authors.forename: Chris H
authors.initials: CH
authors.lastname: Bangma
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aus
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.forename: Xavier
authors.initials: X
authors.lastname: Rebillard
authors.forename: Theodorus
authors.initials: T
authors.lastname: van der Kwast
authors.forename: Bert G
authors.initials: BG
authors.lastname: Blijenberg
authors.forename: Sue M
authors.initials: SM
authors.lastname: Moss
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
mesh_terms: D000367:Age Factors; D000368:Aged; D001706:Biopsy; D051517:Digital Rectal Examination; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D011788:Quality of Life; D012042:Registries; D012044:Regression Analysis; D012306:Risk; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen