title: A different method of evaluation of the ERSPC trial confirms that prostate-specific antigen testing has a significant impact on prostate cancer mortality.
abstract: The advantages and disadvantages of two different methods of analyzing the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial with respect to the effect of prostate-specific antigen (PSA) screening on prostate cancer (PCa) mortality (ie, disease-specific mortality analysis and excess mortality analysis) are discussed in depth. The traditional disease-specific mortality is the best end point, but it could be biased by misclassification of causes of death, and it does not take into account the possible effect of the screening process on other causes of death. Excess mortality analysis overcomes these problems, but the results could be biased if the expected mortality is not corrected for attendance status. Both methods, when applied to the ERSPC trials, demonstrate that no increase in non-PCa mortality occurred in the screening group and confirm that PSA screening decreases PCa mortality.
authors.affiliation: Clinical and Descriptive Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy. Electronic address: m.zappa@ispo.toscana.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Clinical and Descriptive Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy.
authors.forename: Donella
authors.initials: D
authors.lastname: Puliti
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Pim J
authors.initials: PJ
authors.lastname: van Leeuwen
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands; Comprehensive Cancer Centre The Netherlands, Utrecht, The Netherlands.
authors.forename: Ries
authors.initials: R
authors.lastname: Kranse
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Carlsson
authors.affiliation: Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kwiatkowski
authors.affiliation: Provinciaal Instituut voor Hygiëne, Antwerp, Belgium.
authors.forename: Vera
authors.initials: V
authors.lastname: Nelen
authors.affiliation: Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Paez Borda
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.affiliation: Department of Urology, CHU Lille, University Lille Nord de France, Lille, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
mesh_terms: D015982:Bias; D002423:Cause of Death; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D016032:Randomized Controlled Trials as Topic; D013223:Statistics as Topic / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Excess mortality; Screening