Two large trials show prostate screening has limited reduction in mortality
The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial randomly assigned 76,693 men between 55 and 74 years of age to annual PSA screening in combination with digital rectal examination or to usual care.1 After 7 years of (complete) follow-up, screening was associated with increased prostate cancer incidence (relative risk [RR] = 1.2; 95% confidence interval [CI] = 1.2 to 1.3) but had no effect on prostate cancer–specific (RR = 1.1; 95% CI = 0.75 to 1.7) or allcause (RR = 0.98; 95% CI = 0.92 to 1.0) mortality. Similar results were observed after 10 years (67% of sample; RR = 1.1; 95% CI = 0.80 to 1.5). Up to 52% of the men assigned to usual care underwent a PSA test at some point during the trial, and 44% of all trial participants had undergone PSA screening prior to entry.
ERSPC and Göteborg Studies
The European Randomized Study of Screening for Prostate Cancer (ERSPC) randomly assigned 182,000 men aged 50 to 74 years from 7 countries to PSA testing every 2 to 7 years (depending on the center and year) or to usual care.1 Data from 2 other study centers were excluded for reasons not specified in the study protocol. The levels of PSA for diagnostic evaluation ranged from 2.5 to 4.0 μg/L (1 center used 10 μg/L for several years). After a median of 9 years, the incidence of prostate cancer was higher in the screened group (net increase of 34 per 1000 men), but there was no statistically significant difference in prostate cancer–specific mortality (RR = 0.85; 95% CI = 0.73 to 1.0). A prespecified subgroup analysis of 162,243 men aged 55 to 69 years found that screening was associated with reduced prostate cancer–specific mortality (RR = 0.80; 95% CI = 0.65 to 0.98; absolute risk reduction = 0.07 percentage point), for an estimated 1410 men invited to screening and 48 treated to prevent 1 prostate cancer–specific death.
After publication of the main ERSPC results, 1 participating center (Göteborg, Sweden) reported results separately. It found PSA screening (threshold of 2.5 to 3.0 μg/L) every 2 years in 20,000 men aged 50 to 64 years to be associated with increased prostate cancer incidence (hazard ratio = 1.6; 95% CI = 1.5 to 1.8) and decreased risk for prostate cancer–specific mortality (RR = 0.56; 95% CI = 0.39 to 0.82; absolute risk reduction = 0.34 percentage point) after a median of 14 years. Outcomes for 60% of participants were included in the main ERSPC report.