Screening and prostate-cancer mortality in a randomized European study.
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.)
Schröder
Fritz H
FH
Department of Urology , Erasmus Medical Center, Rotterdam, The Netherlands.
Hugosson
Jonas
J
Roobol
Monique J
MJ
Tammela
Teuvo L J
TL
Ciatto
Stefano
S
Nelen
Vera
V
Kwiatkowski
Maciej
M
Lujan
Marcos
M
Lilja
Hans
H
Zappa
Marco
M
Denis
Louis J
LJ
Recker
Franz
F
Berenguer
Antonio
A
Määttänen
Liisa
L
Bangma
Chris H
CH
Aus
Gunnar
G
Villers
Arnauld
A
Rebillard
Xavier
X
van der Kwast
Theodorus
T
Blijenberg
Bert G
BG
Moss
Sue M
SM
de Koning
Harry J
HJ
Auvinen
Anssi
A
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
D017430:Prostate-Specific Antigen