10 Aug PSA Screening and Prostate Cancer Mortality
Medical Research: What are the main findings of the study?
Professor Schröder: I consider as the main finding that we could report a continuing effect of PSA driven screening on prostate cancer mortality for men aged 55 – 69 years in the screen arm of our study after 13 years of follow-up. The absolute reduction in the risk of death from prostate cancer amounts to 1.28 per 1000 men randomized to the screening arm. This translated into numbers to be invited to screening and numbers needed to be diagnosed to save one prostate cancer death of 781 and 27. These figures show an increasing effect with increasing time of follow-up. The relative risk reduction related to the control arm has remained unchanged with respect to the 11 year follow-up period. For men who actually participated and were screened the relative risk reduction amounted to 27%, the figure most applicable to men who consider to be tested.
Medical Research: Were any of the findings unexpected?
Professor Schröder: I am a bit surprised that the relative risk reduction stagnated at 13 years. There are possible explanations for this which are mentioned in the discussion section of our publication. Since only about 30% of all participants have died so far, we do not consider these findings as definite and are curious about the future developments in our ongoing study
Medical Research: What should clinicians and patients take away from your report?
Professor Schröder: Men in the age groups at risk who consider to be PSA tested should be confronted with well-balanced decision aids and come to an individual decision taking account of the potential benefits and harms.
Medical Research: What recommendations do you have for future research as a result of this study?
Professor Schröder: The ESPC study must and will continue. It is the only study capable of producing a definite answer on the value and the down sides of screening. Current efforts to avoid unnecessary prostate biopsies and thereby decrease the amount of over diagnosis by use of the multi parametric Magnetic Resonance Imaging (mpMRI) technology and other new markers which are under development are essential. If over diagnosis can be decreased or avoided the door will be open for population based screening.
Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up
Prof Fritz H Schröder MD,Prof Jonas Hugosson PhD,Monique J Roobol PhD,Prof Teuvo L J Tammela MD,Marco Zappa MD,Vera Nelen MD,Maciej Kwiatkowski MD,Marcos Lujan MD,Liisa Määttänen PhD,Prof Hans Lilja PhD MD,Prof Louis J Denis MD,Prof Franz Recker MD,Alvaro Paez MD,Prof Chris H Bangma MD,Sigrid Carlsson MD,Donella Puliti MSc,Arnauld Villers MD,Xavier Rebillard MD,Prof Matti Hakama PhD,Prof Ulf-Hakan Stenman PhD,Paula Kujala MD,Kimmo Taari MD,Gunnar Aus MD,Prof Andreas Huber MD,Prof Theo H van der Kwast PhD MD,Prof Ron H N van Schaik PhD,Prof Harry J de Koning MD,Prof Sue M Moss PhD,Prof Anssi Auvinen MD,for the ERSPC Investigators
The Lancet – 7 August 2014