title: Prostate-cancer mortality at 11 years of follow-up.
abstract: BACKGROUND
  Several trials evaluating the effect of prostate-specific antigen (PSA) testing on prostate-cancer mortality have shown conflicting results. We updated prostate-cancer mortality in the European Randomized Study of Screening for Prostate Cancer with 2 additional years of follow-up.
  
  
  METHODS
  The study involved 182,160 men between the ages of 50 and 74 years at entry, with a predefined core age group of 162,388 men 55 to 69 years of age. The trial was conducted in eight European countries. Men who were randomly assigned to the screening group were offered PSA-based screening, whereas those in the control group were not offered such screening. The primary outcome was mortality from prostate cancer.
  
  
  RESULTS
  After a median follow-up of 11 years in the core age group, the relative reduction in the risk of death from prostate cancer in the screening group was 21% (rate ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.001), and 29% after adjustment for noncompliance. The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent randomization. The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62 (95% CI, 0.45 to 0.85; P=0.003). To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected. There was no significant between-group difference in all-cause mortality.
  
  
  CONCLUSIONS
  Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality. (Current Controlled Trials number, ISRCTN49127736.).
authors.affiliation: Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands. secr.schroder@erasmusmc.nl
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: Alvaro
authors.initials: A
authors.lastname: Páez
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: Sigrid
authors.initials: S
authors.lastname: Carlsson
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: Paula M
authors.initials: PM
authors.lastname: Kujala
authors.forename: Bert G
authors.initials: BG
authors.lastname: Blijenberg
authors.forename: Ulf-Hakan
authors.initials: UH
authors.lastname: Stenman
authors.forename: Andreas
authors.initials: A
authors.lastname: Huber
authors.forename: Kimmo
authors.initials: K
authors.lastname: Taari
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
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; D002423:Cause of Death; D055088:Early Detection of Cancer; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D012306:Risk
chemical_list: D017430:Prostate-Specific Antigen