Screening and prostate-cancer mortality in a randomized European study
- PMID: 19297566
- DOI: 10.1056/NEJMoa0810084
Screening and prostate-cancer mortality in a randomized European study
Abstract
Background: The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific-antigen (PSA) testing on death rates from prostate cancer.
Methods: We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006.
Results: In the screening group, 82% of men accepted at least one offer of screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P=0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The analysis of men who were actually screened during the first round (excluding subjects with noncompliance) provided a rate ratio for death from prostate cancer of 0.73 (95% CI, 0.56 to 0.90).
Conclusions: PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. (Current Controlled Trials number, ISRCTN49127736.)
2009 Massachusetts Medical Society
Comment in
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Screening for prostate cancer--the controversy that refuses to die.N Engl J Med. 2009 Mar 26;360(13):1351-4. doi: 10.1056/NEJMe0901166. Epub 2009 Mar 18. N Engl J Med. 2009. PMID: 19297564 No abstract available.
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ACP Journal Club. Periodic screening with prostate-specific antigen testing reduced mortality from prostate cancer.Ann Intern Med. 2009 Jun 16;150(12):JC6-5, JC6-4. Ann Intern Med. 2009. PMID: 19528550 No abstract available.
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Prostate-cancer screening.N Engl J Med. 2009 Jul 9;361(2):202; author reply 204-5. doi: 10.1056/NEJMc090849. N Engl J Med. 2009. PMID: 19587348 No abstract available.
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Prostate-cancer screening.N Engl J Med. 2009 Jul 9;361(2):202-3; author reply 204-6. N Engl J Med. 2009. PMID: 19593850 No abstract available.
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Prostate-cancer screening.N Engl J Med. 2009 Jul 9;361(2):204; author reply 205-6. N Engl J Med. 2009. PMID: 19593853 No abstract available.
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Prostate-cancer screening.N Engl J Med. 2009 Jul 9;361(2):204; author reply 204-6. N Engl J Med. 2009. PMID: 19593854 No abstract available.
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Periodic screening with prostate-specific antigen testing reduced mortality from prostate cancer.Evid Based Med. 2009 Aug;14(4):104-5. doi: 10.1136/ebm.14.4.105. Evid Based Med. 2009. PMID: 19648421 No abstract available.
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[PSA screening of 55 to 69 year old men reduces prostate cancer mortality].Praxis (Bern 1994). 2010 Feb 3;99(3):197-8. doi: 10.1024/1661-8157/a000025. Praxis (Bern 1994). 2010. PMID: 20127642 German. No abstract available.
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