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Screening and Prostate-Cancer Mortality in a Randomized European Study

Schroeder, Fritz H.; Hugosson, Jonas; Roobol, Monique J.; Tammela, Teuvo L. J.; Ciatto, Stefano; Nelen, Vera; Kwiatkowski, Maciej; Lujan, Marcos; Lilja, Hans LU and Zappa, Marco, et al. (2009) In New England Journal of Medicine 360(13). p.1320-1328
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... (More)
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.) (Less)
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New England Journal of Medicine
volume
360
issue
13
pages
1320 - 1328
publisher
Massachusetts Medical Society
external identifiers
  • wos:000264524100007
  • scopus:63249118690
ISSN
0028-4793
DOI
10.1056/NEJMoa0810084
language
English
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yes
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725a07c5-04a2-41fe-9f72-9380e8e92097 (old id 1401393)
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2009-06-15 11:10:07
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2017-12-10 03:39:33
@article{725a07c5-04a2-41fe-9f72-9380e8e92097,
  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.)},
  author       = {Schroeder, Fritz H. and Hugosson, Jonas and Roobol, Monique J. and Tammela, Teuvo L. J. and Ciatto, Stefano and Nelen, Vera and Kwiatkowski, Maciej and Lujan, Marcos and Lilja, Hans and Zappa, Marco and Denis, Louis J. and Recker, Franz and Berenguer, Antonio and Maattanen, Liisa and Bangma, Chris H. and Aus, Gunnar and Villers, Arnauld and Rebillard, Xavier and van der Kwast, Theodorus and Blijenberg, Bert G. and Moss, Sue M. and de Koning, Harry J. and Auvinen, Anssi},
  issn         = {0028-4793},
  language     = {eng},
  number       = {13},
  pages        = {1320--1328},
  publisher    = {Massachusetts Medical Society},
  series       = {New England Journal of Medicine},
  title        = {Screening and Prostate-Cancer Mortality in a Randomized European Study},
  url          = {http://dx.doi.org/10.1056/NEJMoa0810084},
  volume       = {360},
  year         = {2009},
}