PSA Screening Reduced Prostate Cancer–Specific but Not Overall Mortality

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“Analyses after 2 additional years of follow-up consolidated our previous finding that [prostate-specific antigen (PSA)]-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality,” investigators from the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported in The New England Journal of Medicine. At a median follow-up of 11 years in the core age group (55 to 69 years old), the relative reduction in the risk of death among the men randomly assigned to the PSA screening group was 21%, and 29% after adjusting for noncompliance.

The ERSPC is a multicenter study that involved 182,160 men between the ages of 50 and 74 when they entered the study, including 162,388 men in the core age group. There were 299 deaths from prostate cancer in the screening group, corresponding to a death rate of 0.39 per 1,000 person-years, and 462 in the control group, corresponding to a death rate of 0.50.

“The absolute reduction in mortality in the screening group was 0.10 deaths per 1,000 person-years or 1.07 deaths per 1,000 men who underwent randomization,” the investigators stated. “To prevent one death from prostate cancer at 11 years of follow-up, 1,055 men would need to be invited for screening and 37 cancers would need to be detected.”

Overall mortality was similar among men who had PSA screening and those who did not. There were 18.2 deaths per 1,000 person-years in the screening group and 18.5 per 1,000 person-years in the control group.

Controversy Renewed

“The controversy regarding screening for prostate cancer has been renewed by the publication of the draft report of the U.S. Preventive Services Task Force, which after a literature-based analysis of benefits and harms recommended against the use of PSA testing in asymptomatic men,” the authors noted in the discussion section of their study report. “Clearly, the issue can be resolved only on the basis of evidence that considers both the advantages and disadvantages of screening, data that are not available at this time,” they added. ■

Schröder FH, et al: N Engl J Med 366:981-990, 2012.




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