Prostate Cancer Screening Reduces Mortality

Regular prostate-specific antigen (PSA) screening reduces the risk of death from prostate cancer by 13%, according to a large-scale European study. The results, published in the New England Journal of Medicine, indicate that the benefits of such screening become more evident over long periods of time.

The findings come from the European Randomized Study of Screening for Prostate Cancer (ERSPC), which began in 1993. With a median follow-up of 23 years, the study represents one of the largest randomized trials of its kind.

The Scope of the ERSPC Study

The ERSPC trial involved 162,236 men between the ages of 55 and 69 across eight European countries. Participants were randomly assigned to one of two groups: a screening group offered repeated PSA testing or a control group that received standard care without an invitation for screening.

The primary objective of the research was to assess the effect of PSA testing on prostate cancer mortality. After more than two decades of observation, the data showed a rate ratio of 0.87 for prostate cancer mortality in the screening group, representing a 13% reduction compared to the control group.

The study reported an absolute risk reduction of 0.22%. This overall reduction in mortality is similar to the reductions seen with bowel or breast cancer screening.

Improved Efficacy in Death Prevention

The long-term analysis indicates that the balance between the benefits of screening and the potential harms has improved over time. Researchers found that for every 456 men invited for screening, one death from prostate cancer was prevented.

This figure is an improvement over earlier results from the same study, which indicated that 628 men needed to be invited for screening to prevent one death. Similarly, only 12 men now need to be diagnosed to prevent one death, compared to 18 in previous analyses.

The study further noted that 22 prostate cancer deaths were prevented per 10,000 men screened, an increase from the 14 deaths prevented per 10,000 men reported in earlier analyses.

The Challenge of Overdiagnosis

While the study confirms a reduction in mortality, it also highlights ongoing challenges regarding overdiagnosis. The screening group saw a modest increase in prostate cancer diagnoses, with 27 extra cases identified per 1,000 men.

Overdiagnosis occurs when screening detects cancers that are slow-growing and would not have caused symptoms or death during the patient’s lifetime, potentially leading to unnecessary treatments.

These long-term results show that PSA screening saves lives. We now have a clearer picture of the benefits, which become more evident as time goes on, while the potential harms of overdiagnosis are gradually reducing.

Professor Monique J. Roobol, lead researcher at Erasmus MC Cancer Institute in Rotterdam

The cumulative incidence of prostate cancer was higher in the screening group than in the control group, with a rate ratio of 1.30.

Researchers suggest that these findings could help shape future screening policies and improve the early detection of the disease as life expectancy and population growth continue to increase the global risk of prostate cancer deaths.