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Word of the Day

Need to screen 1055 and treat 37 to prevent one prostate CA death over 11 years (ERSPC)

Clinical Question:
Does prostate cancer screening reduce disease-specific mortality or all-cause mortality?

Bottom Line:
Prostate cancer screening results in a small decrease in disease-specific mortality, but at a high price, and with no decrease in all-cause mortality. This differs from the results of the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial, which found no reduction in mortality after a similar duration of follow-up. (LOE = 1b)

Reference:
Schröder FH, Hugosson J, Roobol MJ, et al, for the ERSPC Investigators. Prostate cancer mortality at 11 years of follow-up. N Engl J Med 2012;366(11):981-990.  [PMID:22417251]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Government

Allocation:
Concealed

Setting:
Population-based

Synopsis:
This is an update of the European Randomized Study of Screening for Prostate Cancer (ERSPC), and reports results after 11 years of follow-up. The study was done in 8 countries, and there were varying screening intervals (every 2 years in Sweden; every 4 years in the rest) and varying definitions of abnormal prostate-specific antigen (PSA) test results. A total of 182,160 men, aged 50 years to 74 years, were invited to participate, of whom 162,388 were in the "core" age group of 55 years to 69 years. In the group of 72,891 patients randomized to receive screening, there were 6963 prostate cancers diagnosed and 299 deaths due to prostate cancer. In the control group of 89,352 patients, there were 5396 prostate cancers diagnosed and 462 deaths due to prostate cancer. The authors calculate that you would have to invite 1055 men for screening over an 11-year period and detect and treat 37 of those men for prostate cancer to prevent one prostate cancer death. There was no difference between groups in all-cause mortality (18.2 vs 18.5 deaths/1000 person-years). Disadvantages of screening noted by the authors include septic complications of biopsy, limited benefit of treatment compared with watchful waiting, and treatment complications such as impotence and incontinence.

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