title: Prostate cancer mortality reduction by prostate-specific antigen-based screening adjusted for nonattendance and contamination in the European Randomised Study of Screening for Prostate Cancer (ERSPC).
abstract: BACKGROUND
  Prostate-specific antigen (PSA) based screening for prostate cancer (PCa) has been shown to reduce prostate specific mortality by 20% in an intention to screen (ITS) analysis in a randomised trial (European Randomised Study of Screening for Prostate Cancer [ERSPC]). This effect may be diluted by nonattendance in men randomised to the screening arm and contamination in men randomised to the control arm.
  
  
  OBJECTIVE
  To assess the magnitude of the PCa-specific mortality reduction after adjustment for nonattendance and contamination.
  
  
  METHODS
  We analysed the occurrence of PCa deaths during an average follow-up of 9 yr in 162,243 men 55-69 yr of age randomised in seven participating centres of the ERSPC. Centres were also grouped according to the type of randomisation (ie, before or after informed written consent).
  
  
  METHODS
  Nonattendance was defined as nonattending the initial screening round in ERSPC. The estimate of contamination was based on PSA use in controls in ERSPC Rotterdam.
  
  
  METHODS
  Relative risks (RRs) with 95% confidence intervals (CIs) were compared between an ITS analysis and analyses adjusting for nonattendance and contamination using a statistical method developed for this purpose.
  
  
  CONCLUSIONS
  In the ITS analysis, the RR of PCa death in men allocated to the intervention arm relative to the control arm was 0.80 (95% CI, 0.68-0.96). Adjustment for nonattendance resulted in a RR of 0.73 (95% CI, 0.58-0.93), and additional adjustment for contamination using two different estimates led to estimated reductions of 0.69 (95% CI, 0.51-0.92) to 0.71 (95% CI, 0.55-0.93), respectively. Contamination data were obtained through extrapolation of single-centre data. No heterogeneity was found between the groups of centres.
  
  
  CONCLUSIONS
  PSA screening reduces the risk of dying of PCa by up to 31% in men actually screened. This benefit should be weighed against a degree of overdiagnosis and overtreatment inherent in PCa screening.
authors: Department of Urology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. m.roobol@erasmusmc.nl
authors: Monique J
authors: MJ
authors: Roobol
authors: Melissa
authors: M
authors: Kerkhof
authors: Fritz H
authors: FH
authors: Schröder
authors: Jack
authors: J
authors: Cuzick
authors: Peter
authors: P
authors: Sasieni
authors: Matti
authors: M
authors: Hakama
authors: Ulf Hakan
authors: UH
authors: Stenman
authors: Stefano
authors: S
authors: Ciatto
authors: Vera
authors: V
authors: Nelen
authors: Maciej
authors: M
authors: Kwiatkowski
authors: Marcos
authors: M
authors: Lujan
authors: Hans
authors: H
authors: Lilja
authors: Marco
authors: M
authors: Zappa
authors: Louis
authors: L
authors: Denis
authors: Franz
authors: F
authors: Recker
authors: Antonio
authors: A
authors: Berenguer
authors: Mirja
authors: M
authors: Ruutu
authors: Paula
authors: P
authors: Kujala
authors: Chris H
authors: CH
authors: Bangma
authors: Gunnar
authors: G
authors: Aus
authors: Teuvo L J
authors: TL
authors: Tammela
authors: Arnauld
authors: A
authors: Villers
authors: Xavier
authors: X
authors: Rebillard
authors: Sue M
authors: SM
authors: Moss
authors: Harry J
authors: HJ
authors: de Koning
authors: Jonas
authors: J
authors: Hugosson
authors: Anssi
authors: A
authors: Auvinen
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data
chemical_list: D017430:Prostate-Specific Antigen