Absolute Effect of Prostate Cancer Screening: Balance of Benefits and Harms by Center within the European Randomized Study of Prostate Cancer Screening.
OBJECTIVE
The balance of benefits and harms in prostate cancer screening has not been sufficiently characterized. We related indicators of mortality reduction and overdetection by center within the European Randomized Study of Prostate Cancer Screening (ERSPC).


METHODS
We analyzed the absolute mortality reduction expressed as number needed to invite (NNI = 1/absolute risk reduction; indicating how many men had to be randomized to screening arm to avert a prostate cancer death) for screening and the absolute excess of prostate cancer detection as number needed for overdetection (NNO = 1/absolute excess incidence; indicating the number of men invited per additional prostate cancer case), and compared their relationship across the seven ERSPC centers.


RESULTS
Both absolute mortality reduction (NNI) and absolute overdetection (NNO) varied widely between the centers: NNI, 200-7,000 and NNO, 16-69. Extent of overdiagnosis and mortality reduction was closely associated [correlation coefficient, r = 0.76; weighted linear regression coefficient, β = 33; 95% confidence interval (CI), 5-62; R(2) = 0.72]. For an averted prostate cancer death at 13 years of follow-up, 12 to 36 excess cases had to be detected in various centers.


CONCLUSIONS
The differences between the ERSPC centers likely reflect variations in prostate cancer incidence and mortality, as well as in screening protocol and performance. The strong interrelation between the benefits and harms suggests that efforts to maximize the mortality effect are bound to increase overdiagnosis and might be improved by focusing on high-risk populations. The optimal balance between screening intensity and risk of overdiagnosis remains unclear.
University of Tampere, School of Health Sciences, Tampere, Finland. anssi.auvinen@uta.fi.
Anssi
A
Auvinen
Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom.
Sue M
SM
Moss
Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Finland.
Teuvo L J
TL
Tammela
Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Kimmo
K
Taari
Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Monique J
MJ
Roobol
Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Fritz H
FH
Schröder
Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Chris H
CH
Bangma
Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York.
Sigrid
S
Carlsson
Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Gunnar
G
Aus
Clinical and Descriptive Epidemiology and Registries Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy.
Marco
M
Zappa
Clinical and Descriptive Epidemiology and Registries Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy.
Donella
D
Puliti
Provinciaal Instituut voor Hygiene, Antwerp, Belgium.
Louis J
LJ
Denis
Provinciaal Instituut voor Hygiene, Antwerp, Belgium.
Vera
V
Nelen
Department of Urology, Kantonsspital Aarau, Aarau, Switzerland. Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
Maciej
M
Kwiatkowski
Department of Urology, Kantonsspital Aarau, Aarau, Switzerland. Department of Urology, University Hospital Zürich, Zürich, Switzerland.
Marco
M
Randazzo
Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
Alvaro
A
Paez
Urology Department, Hospital Infanta Cristina, Parla, Madrid, Spain.
Marcos
M
Lujan
Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Jonas
J
Hugosson
D000368:Aged; D014408:Biomarkers, Tumor; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods; D005060:Europe; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009026:Mortality; D015337:Multicenter Studies as Topic; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen