Screening and prostate-cancer mortality in a randomized European study
Fritz H Schröder, Jonas Hugosson, Monique J Roobol, Teuvo L J Tammela, Stefano Ciatto, Vera Nelen, Maciej Kwiatkowski, Marcos Lujan, Hans Lilja, Marco Zappa, Louis J Denis, Franz Recker, Antonio Berenguer, Liisa Määttänen, Chris H Bangma, Gunnar Aus, Arnauld Villers, Xavier Rebillard, Theodorus van der Kwast, Bert G Blijenberg, Sue M Moss, Harry J de Koning, Anssi Auvinen, ERSPC Investigators, P Smith, J Adolfsson, T Hakulinen, J Chamberlain, B Collette, F Alexander, I de Beaufort, W J Kirkels, J B W Rietbergen, I W van der Cruijsen, R Raaijmakers, S H de Vries, S Roemeling, C Gosselaar, T Wolters, R C N van den Bergh, P J van Leeuwen, G Yurdakul, A Boeken-Kruger, C Wijburg, M Forouzanfor, M De Boer, R Postma, A N Vis, R Hoedemaeker, A Van Leenders, R van Schaik, P J van der Maas, S Otto, G Draisma, P Beemsterboer, M Essink-Bot, I Korfage, R Boer, M Wildhagen, E Heijnsdijk, W Merkelbach, W Hoekstra, J Blom, R A M Damhuis, A Reedijk, R Kranse, D W Roobol, W Roobol, E van den Berg, G-J de Zwart, C G A M Franken-Raab, M van Slooten-Midderig, A Smit, V van der Drift, E de Bilde, L Mani, M Visser-van Dongen, H Versteeg-Leenheer, B Zoutendijk, N Vink, H van Meurs, A E de Bruijn, H Devriendt, G Thijs, A Hermans, K D'Hooge, H Neels, A Wauters, I Neetens, M Kockx, F Keuppens, J Braeckman, F Govaerts, B Spinnewijn, M Van Hoey, T Putzeys, M De Coninck, B Dourcy-Belle-Rose, A Vancauwenbergh, J W Coebergh, H Verhaegen, Van Vliet, B Standaert, Maria Nyberg, Svante Bergdahl, Pär Lodding, Ali Khatami, Johan Stranne, Helén Ahlgren, Gun-Britt Eriksson, Charlotte Becker, Sigrid Carlsson, Anna Grenabo, Silas Pettersson, Eberhard Varenhorst, Bo-Johan Norlén, Björn Zackrisson, Erik Holmberg, Roland Frösing, Erik Pileblad, Carl-Gustaf Pihl, Paula Kujala, Marita Laurila, Ulf-Håkan Stenman, Patrik Finne, Mirja Ruutu, Martti Ala-Opas, Jussi Aro, Harri Juusela, Markus Mildh, Matti Hakama, Jorma Lahtela, Pekka J Karhunen, Tuukka Mäkinen, Tapio Visakorpi, Jorma Isola, Mario Cappellini, Simonetta Bianchi, Claudio Lombardi, Alessandro Bussotti, Paolo Bastiani, Rita Bonardi, Antonia Mazzotta, Dusca Bartoli, Liana Bonfrisco, Emanuele Crocetti, Francesca Martinelli, Paola Zendron, Paola Frullini, Simonetta Di Lollo, Tiziana Rubeca, Alvaro Páez, Carlos Pascual, Carlos Santonja, Andreas Huber, Reto Tscholl, Bernhard Stamm, Martin Wernli, Michael Kurrer, Stephan Bodis, Thomas Lautenschlager, Lukas Bubendorf, Kurt Lehmann, Giorgio Bugliani, Johann Steurer, J Hemming, P Coulson, D Coleman, Th Van der Kwast, G J van Leenders, R F Hoedemaeker, C-G Pihl, P M Martikainen, M Laurila, L Bubendorf, C Santonja, I Neetens, S DiLollo, C Mazerolles, C Lopes, Fritz H Schröder, Jonas Hugosson, Monique J Roobol, Teuvo L J Tammela, Stefano Ciatto, Vera Nelen, Maciej Kwiatkowski, Marcos Lujan, Hans Lilja, Marco Zappa, Louis J Denis, Franz Recker, Antonio Berenguer, Liisa Määttänen, Chris H Bangma, Gunnar Aus, Arnauld Villers, Xavier Rebillard, Theodorus van der Kwast, Bert G Blijenberg, Sue M Moss, Harry J de Koning, Anssi Auvinen, ERSPC Investigators, P Smith, J Adolfsson, T Hakulinen, J Chamberlain, B Collette, F Alexander, I de Beaufort, W J Kirkels, J B W Rietbergen, I W van der Cruijsen, R Raaijmakers, S H de Vries, S Roemeling, C Gosselaar, T Wolters, R C N van den Bergh, P J van Leeuwen, G Yurdakul, A Boeken-Kruger, C Wijburg, M Forouzanfor, M De Boer, R Postma, A N Vis, R Hoedemaeker, A Van Leenders, R van Schaik, P J van der Maas, S Otto, G Draisma, P Beemsterboer, M Essink-Bot, I Korfage, R Boer, M Wildhagen, E Heijnsdijk, W Merkelbach, W Hoekstra, J Blom, R A M Damhuis, A Reedijk, R Kranse, D W Roobol, W Roobol, E van den Berg, G-J de Zwart, C G A M Franken-Raab, M van Slooten-Midderig, A Smit, V van der Drift, E de Bilde, L Mani, M Visser-van Dongen, H Versteeg-Leenheer, B Zoutendijk, N Vink, H van Meurs, A E de Bruijn, H Devriendt, G Thijs, A Hermans, K D'Hooge, H Neels, A Wauters, I Neetens, M Kockx, F Keuppens, J Braeckman, F Govaerts, B Spinnewijn, M Van Hoey, T Putzeys, M De Coninck, B Dourcy-Belle-Rose, A Vancauwenbergh, J W Coebergh, H Verhaegen, Van Vliet, B Standaert, Maria Nyberg, Svante Bergdahl, Pär Lodding, Ali Khatami, Johan Stranne, Helén Ahlgren, Gun-Britt Eriksson, Charlotte Becker, Sigrid Carlsson, Anna Grenabo, Silas Pettersson, Eberhard Varenhorst, Bo-Johan Norlén, Björn Zackrisson, Erik Holmberg, Roland Frösing, Erik Pileblad, Carl-Gustaf Pihl, Paula Kujala, Marita Laurila, Ulf-Håkan Stenman, Patrik Finne, Mirja Ruutu, Martti Ala-Opas, Jussi Aro, Harri Juusela, Markus Mildh, Matti Hakama, Jorma Lahtela, Pekka J Karhunen, Tuukka Mäkinen, Tapio Visakorpi, Jorma Isola, Mario Cappellini, Simonetta Bianchi, Claudio Lombardi, Alessandro Bussotti, Paolo Bastiani, Rita Bonardi, Antonia Mazzotta, Dusca Bartoli, Liana Bonfrisco, Emanuele Crocetti, Francesca Martinelli, Paola Zendron, Paola Frullini, Simonetta Di Lollo, Tiziana Rubeca, Alvaro Páez, Carlos Pascual, Carlos Santonja, Andreas Huber, Reto Tscholl, Bernhard Stamm, Martin Wernli, Michael Kurrer, Stephan Bodis, Thomas Lautenschlager, Lukas Bubendorf, Kurt Lehmann, Giorgio Bugliani, Johann Steurer, J Hemming, P Coulson, D Coleman, Th Van der Kwast, G J van Leenders, R F Hoedemaeker, C-G Pihl, P M Martikainen, M Laurila, L Bubendorf, C Santonja, I Neetens, S DiLollo, C Mazerolles, C Lopes
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
Source: PubMed