by ecancer reporter Janet Fricker

Prostate-specific antigen (PSA) screening significantly reduced mortality from prostate cancer but had no affect on all-cause mortality, find the latest results from the ERSPC study. The results at 11 years follow-up, published in the New England Journal of Medicine, add two more years to the original analysis.

Several trials evaluating the effect of prostate-specific antigen (PSA) testing on prostate-cancer mortality have shown conflicting results. The controversy regarding screening for prostate cancer has recently been  renewed by the publication of the report of the U.S. Preventive Services Task Force, which after a literature-based analysis of the benefits and harms recommended against the use of PSA testing in asymptomatic men.

The European Randomized Study of Screening for Prostate Cancer (ERSPC) is a multicentre  trial that was initiated in 1991 in the Netherlands and Belgium, with Sweden, Finland, Italy, Spain and Switzerland joining between 1994 and 1998. 

In the study, which involved 182,160 men between the ages of 50 and 74 years at entry, the men were randomly assigned to the screening group offered PSA-based screening or the control group who were not offered screening. The primary outcome was prostate cancer mortality.

The results show that there were 299 deaths from prostate cancer in the screening group and 462 in the control group, with deaths rates of 0.30 and 0.50 per 1000 person years respectively (P=0.001).

The relative reduction in the risk of death from prostate cancer in the screening group was 21% The investigators calculated that to prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected.

The overall mortality, however, was similar in the two groups, with 18.2 deaths per 1000 person-years in the screening group and 18.5 per 1000 person years in the control group .

“Despite the reduction in the rate of death from prostate cancer, screening had no effect on all-cause mortality,” write the authors. More information on the balance of benefits and adverse effects as well as cost-effectiveness, are needed, they write, before general recommendations can be made.

Reference

F Schroder, J Hugosson, M Roobol, et al. Prostate-Cancer Mortality at 11 Years of Follow-up. N Engl J Med March 15 2012, 366:981-90.