What can be concluded from the ERSPC and PLCO trial data?
OBJECTIVE
The interim analyses of the long-awaited erSPC and PlCo trial data have generated conflicting conclusions regarding the value of screening for prostate cancer based on measurements of PSA.


METHODS
We review the two publications and speculate on reasons underlying the contradicting conclusion of the two studies.


RESULTS
The apparently negative results of the PlCO trial may be in part because a part of the patients enrolled were "prescreened", because of failure to biopsy some patients with PSA > 4 ng/ml, because of contamination in the control arm and because of the relatively short follow-up. However, both reports address the serious problem of overdetection and subsequent overtreatment, as the positive predictive value of positive biopsies triggered by positive PSA in the ERPC study was only 24% and many detected cancers were of low-risk.


CONCLUSIONS
Until more sensitive and more specific screening tools are available that can detect the few cases of prostate cancer with aggressive biological potential among the majority of indolent cases, physicians and patients must understand that most diagnosed prostate cancers will never lead to death and that men can only profit from early detection if local and systemic treatment are limited to those patients who truly need it.
Department of Urology, University Hospital Bern, Bern, Switzerland. urs.studer@insel.ch
Urs E
UE
Studer
Laurence
L
Collette
D014408:Biomarkers, Tumor / Q000032:analysis*; D002986:Clinical Trials as Topic; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D012107:Research Design
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen