The number of men needed to be invited for screening to prevent one PCa death was at 16yr compared with at 13yr. The number needed to diagnose was reduced to 18 from 26 at 13yr.
Conclusions: Findings corroborate earlier results that PSA screening significantly reduces PCa mortality, showing larger absolute benefit with longer follow-up and a reduction in excess incidence. Stage migration has been one of the most significant changes in the PSA screening era.
Catalona and colleagues 20 first reported a decrease in advanced prostate cancer in the screened population in The PLCO trial Table 5 found that the characteristics of patients were similar in both groups, and that regardless of screening or control group or mode of detection, the majority of tumors were stage II at diagnosis.
The study, moreover, found little difference between the detection at other stages, with screening and control groups showing similar results. The complication at this point is the contamination of the control group, as it cannot be determined whether there was actually no benefit to those screened in terms of tumor stage or if the control group was screened to an extent where the effects of screening rivaled those of the annual tests.
The findings regarding the risk of overdiagnosis and overtreatment remain the most intriguing aspect of the current prostate cancer screening discussion. These are especially important if results continue to show little impact on mortality as well as increasing stress placed on the patient through overdiagnosis and overtreatment. It has been shown that there is a difference in QoL between different treatments for prostate cancer.
As the results are ambiguous concerning mortality, the question of how to screen and treat to prevent mortality remains. Consequently, DRE may be a worthwhile test for future examination. The decline in mortality rates are quite small compared with the large number of men diagnosed and treated for prostate cancer.
Both studies mention the need for further investigations that assess the relationship between prostate cancer screening, treatment, and quality of life. This is especially important if results continue to show little impact on mortality and increasing stress placed on the patient through overdiagnosis and overtreatment. National Center for Biotechnology Information , U.
Journal List Rev Urol v. Rev Urol. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract The advent of prostate-specific antigen PSA testing in the early s revolutionized the diagnosis of prostate cancer. Prostate Cancer Screening The ideal screening test is minimally invasive, readily available, easily performed, acceptable to the general population, accurate, and significantly affects the outcome of disease such as the mortality rate.
Open in a separate window. Positive PSA tests 20, PSA, prostate-specific antigen. Conclusions The findings regarding the risk of overdiagnosis and overtreatment remain the most intriguing aspect of the current prostate cancer screening discussion.
Main Points. References 1. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. Mortality results from a randomized prostate-cancer screening trial [published erratum in N Engl J Med. Prostate cancer screening and PSA. Prim Care: Clin Office Pract. In press. Causes of death in elderly prostate cancer patients and in a comparison nonprostate cancer cohort. J Natl Cancer Inst.
Teuvo L. Louis J. Chris H. Ron H. Harry J. Sue M. Author information Copyright and License information Disclaimer. Correspondence Fritz H. Copyright notice. The publisher's final edited version of this article is available at Lancet. See other articles in PMC that cite the published article. Associated Data Supplementary Materials Abstract Background The European Randomized study of Screening for Prostate Cancer ERSPC is a randomized multi-center trial with a predefined centralized database, analysis plan and core age group 55—69 years evaluating prostate-specific antigen PSA testing in eight European countries.
Methods The present results are based on prostate cancer PCa incidence and mortality truncated at 9, 11, and 13 years of follow-up in the intervention arm offered PSA testing relative to the control arm.
Interpretation This update of ERSPC confirms a substantial PCa mortality reduction due to PSA testing, with a substantially increased absolute effect at 13 years compared to findings after 9 and 11 years.
Keywords: Prostate cancer, prostate specific antigen PSA , randomised controlled trial, mortality, mass screening. Methods Study design The ERSPC is a multi-center, randomized screening trial with the main goal to compare PCa mortality between an intervention arm invited to screening and a control arm with no intervention offered. Recruitment of participants Recruitment was completed by the end of , except in France with recruitment up to Primary end-points The primary endpoint of the study is PCa mortality Statistical analysis The primary analysis evaluated PCa mortality and addressed the upfront agreed core age group 55—69 years, with follow-up through truncated at 9, 11 and 13 years.
Results Screening results In the core age group of men aged 55—69 years, excluding France, , were randomized, of whom died between randomization and screening. Open in a separate window. Figure 1. Table 1 Randomization, participants and results of screening all centres core age group, cut-off date December 31, , data truncated at 13 years of follow-up.
Prostate cancer incidence and mortality With follow-up truncated at 13 years, PCa incidence was 9. Tables 2a and 2b Prostate cancer incidence and mortality in the intervention and control arms during 3 time periods truncated — All centers, core age group, France excluded except for years 1—9. Figure 2. France — 35 21—96 — 27 17— Table 4 All cause and prostate cancer mortality by age at randomization, France excluded.
Figure 3. Discussion The results of our primary analysis based on extended follow-up up to 13 years indicate no further increase in the relative effect of screening on PCa mortality with an RR of 0.
Differences between age groups and centers PCa mortality was significantly lower in the screened arm in the core age group and for all ages. What clinicians and healthcare providers need to know The fact that the time of population based screening has not come should not withhold clinicians and other healthcare providers to consider the application of PSA driven testing to men who wish to undergo such study. Supplementary Material 01 Click here to view.
Footnotes Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication.
Contributors All authors have, among others, contributed by including substantial numbers of participants, as indicated in table 1 of the web extra Material, by providing data to the independent data center twice a year, and by critically revising the manuscript for important intellectual content. References 1. Screening and prostate-cancer mortality in a randomized European study.
N Engl J Med. Prostate-cancer mortality at 11 years of follow-up. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized study of Screening for Prostate Cancer. J Natl Cancer Inst. The changing face of low-risk prostate cancer: trends in clinical presentation and primary management. J Clin Oncol. Quality-of-life effects of Prostate-Specific Antigen screening.
European randomized study of screening for prostate cancer —The Rotterdam pilot studies. Int J Cancer. European randomized study of screening for prostate cancer: Progress report of Antwerp and Rotterdam pilot studies. European Randomized study of Screening for Prostate Cancer. European Randomized study of Screening for Prostate Cancer: achievements and presentation. BJU Int. Scientists, patient representatives, urologists and politicians covered key topics such as the latest evidence, consequences of not performing PSA screening, overdiagnosis and overtreatment in a very well-attended session.
After an intense route via the Swiss Alps, the question is what will we do next? Will we take a left turn and slowly disappear into the sea like Venice or return to the valleys in Switzerland? Risk-adapted Screening Prof. Peter Albers DE explained why we should adopt structured population-based PSA screening for prostate cancer at an early stage by comparing screening programmes for other types of cancer. Lessons learned in Sweden In Sweden, prostate cancer is a major public health problem, according to Prof.
Per-Anders Abrahamsson. His five golden rules for transforming PSA screening are the first step to success.
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