# ERSPC: screening and prostate cancer mortality in a randomised European study

Source: https://onco.cc/key-papers/paper-schroder-erspc-screening-mortality-nejm-2009/  
OnCo record `paper-schroder-erspc-screening-mortality-nejm-2009` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The trial that showed PSA screening does save lives, and showed what it costs. Screening cut the death rate from prostate cancer by a fifth, but 1,410 men had to be screened and 48 extra cancers treated to prevent one death.

## Summary

Fritz Schröder, Jonas Hugosson and the ERSPC investigators identified 182,000 men aged 50 to 74 through registries in seven European countries and randomised them to prostate-specific antigen screening on average once every four years or to no screening offer. The predefined core age group was the 162,243 men aged 55 to 69, and the primary outcome was death from prostate cancer.

The headline is a 20 percent reduction in prostate cancer mortality. The two numbers beneath it are what the field has argued about ever since: an absolute risk difference of 0.71 deaths per 1,000 men after a median 9 years, and a cumulative prostate cancer incidence of 8.2 percent in the screened group against 4.8 percent in the control group. The trial's own conclusion names the trade-off explicitly: screening reduced death but was associated with a high risk of overdiagnosis. The 16-year follow-up (paper-hugosson-eur-urol) improves the absolute numbers as the benefit accrues, without changing the shape of the trade.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Also known as: ERSPC; European Randomized Study of Screening for Prostate Cancer; Schroder 2009
- Tags: prostate-evidence
- Journal: New England Journal of Medicine
- Year: 2009
- DOI: 10.1056/nejmoa0810084
- Authors: Schröder FH, Hugosson J, Roobol MJ, et al.
- Findings: Rate ratio for death from prostate cancer in the screening group 0.80 (95 percent confidence interval 0.65 to 0.98; adjusted P equals 0.04), a 20 percent reduction.; Absolute risk difference 0.71 death per 1,000 men; 1,410 men would need to be screened and 48 additional cases treated to prevent one death from prostate cancer.; Cumulative incidence of prostate cancer over a median 9 years of follow-up 8.2 percent in the screening group and 4.8 percent in the control group.; 82 percent of men in the screening group accepted at least one offer of screening.; Among men actually screened in the first round, excluding non-compliers, the rate ratio for death from prostate cancer was 0.73 (0.56 to 0.90).
- What it means: The evidence that prostate-specific antigen screening works, stated together with the price. It is the reason screening programmes are debated rather than simply adopted, and the reason every subsequent proposal, from magnetic resonance imaging first to risk-model invitation, is judged on whether it keeps the mortality benefit while reducing the 48.
- Caveats: Seven countries with different screening intervals, thresholds and biopsy protocols pooled into one trial, so the intervention is not uniform.; The absolute benefit at 9 years is small because prostate cancer mortality is a slow endpoint; longer follow-up increases it, as the 16-year report shows.; Contamination in the control group (unplanned prostate-specific antigen testing) dilutes the measured effect in some centres.; The trial randomised testing, not a modern pathway: there was no magnetic resonance imaging triage and no active surveillance as it is practised now, both of which change the overdiagnosis half of the trade.

## Sources

- N Engl J Med 2009: https://doi.org/10.1056/nejmoa0810084
- PubMed: https://pubmed.ncbi.nlm.nih.gov/19297566/
- ISRCTN49127736: https://www.isrctn.com/ISRCTN49127736

## Connected records

- key papers: [A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer](https://onco.cc/key-papers/paper-hugosson-eur-urol/), [Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context](https://onco.cc/key-papers/paper-draisma-lead-time-overdiagnosis-psa-jnci-2009/), [Measurement of prostate-specific antigen in serum as a screening test for prostate cancer](https://onco.cc/key-papers/paper-catalona-psa-screening-test-nejm-1991/), [PLCO: mortality results from a randomised prostate cancer screening trial](https://onco.cc/key-papers/paper-andriole-plco-prostate-screening-nejm-2009/), [Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only](https://onco.cc/key-papers/paper-goteborg-2-n-engl-j-med-2022/), [Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial](https://onco.cc/key-papers/paper-martin-jama/), [USPSTF 2012: screening for prostate cancer, recommendation statement (grade D)](https://onco.cc/key-papers/paper-moyer-uspstf-prostate-screening-ann-intern-med-2012/)
- roadmaps: [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [PSA and MRI-first prostate cancer screening](https://onco.cc/technologies/prostate-screening-psa-mri/)
- terms: [Lead time, and lead-time bias](https://onco.cc/terms/lead-time-bias/), [Number needed to screen (and number needed to diagnose)](https://onco.cc/terms/number-needed-to-screen/), [Overdiagnosis](https://onco.cc/terms/overdiagnosis/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [Screening](https://onco.cc/terms/screening/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- ideas: [Judge a prostate screening programme on metastatic presentation, not on incidence or mortality](https://onco.cc/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/)

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