{"entity":{"id":"paper-andriole-plco-prostate-screening-nejm-2009","kind":"paper","name":"PLCO: mortality results from a randomised prostate cancer screening trial","aka":["PLCO prostate","Andriole 2009","Prostate, Lung, Colorectal and Ovarian screening trial prostate arm"],"tldr":"The American screening trial, published in the same issue as the European one and reaching the opposite conclusion. It found more cancers in the screened group and no difference in deaths, which is partly because half the men in the comparison group were being screened anyway.","summary":"Gerald Andriole and the PLCO Project Team randomised 76,693 men at 10 United States centres to annual prostate-specific antigen testing for six years with digital rectal examination for four, or to usual care. It appeared alongside the first ERSPC report on 26 March 2009.\n\nThe result was no significant difference in prostate cancer mortality, and the reason is in the paper's own numbers: screening in the usual-care group rose from 40 percent in the first year to 52 percent by the sixth. PLCO therefore compared organised screening with widespread opportunistic screening, not with no screening. Reading the two 2009 papers together is the single most useful exercise in the prostate screening literature, because they are usually quoted as a disagreement about whether screening works when they are largely a disagreement about what the control arm was.","asOf":"2026-09-25","links":[{"label":"N Engl J Med 2009","url":"https://doi.org/10.1056/nejmoa0810696"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/19297565/"},{"label":"ClinicalTrials.gov NCT00002540","url":"https://clinicaltrials.gov/study/NCT00002540"}],"tags":["prostate-evidence"],"related":["paper-schroder-erspc-screening-mortality-nejm-2009","paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011","paper-moyer-uspstf-prostate-screening-ann-intern-med-2012","early-detection-roadmap","prostate-roadmap"],"cancers":["prostate","prostate-low-risk","prostate-intermediate-risk"],"sections":["early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["psa","screening","number-needed-to-screen","lead-time-bias"],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-trial-design","b-overdiagnosis"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2009,"doi":"10.1056/nejmoa0810696","pmid":"19297565","authors":"Andriole GL, Crawford ED, Grubb RL, et al.","paperType":"rct","findings":["After 7 years of follow-up, prostate cancer incidence per 10,000 person-years was 116 (2,820 cancers) in the screening group and 95 (2,322 cancers) in the control group; rate ratio 1.22 (95 percent confidence interval 1.16 to 1.29).","Prostate cancer deaths per 10,000 person-years were 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group; rate ratio 1.13 (0.75 to 1.70).","Screening in the control group rose from 40 percent in the first year to 52 percent in the sixth for prostate-specific antigen testing, and ranged from 41 to 46 percent for digital rectal examination.","Compliance in the screening group was 85 percent for prostate-specific antigen testing and 86 percent for digital rectal examination.","Data at 10 years were 67 percent complete and consistent with the overall findings."],"whatItMeans":"The trial that made prostate screening contested in the United States, and the reason the 2012 task force recommended against it. Its main lesson is methodological: a screening trial whose control group screens itself cannot measure the effect of screening.","caveats":["Heavy contamination of the control arm (52 percent screened by year six) means the comparison is organised against opportunistic screening.","Seven years of follow-up is short for prostate cancer mortality; the trial's own 10-year data were only 67 percent complete at publication.","Substantial pre-trial prostate-specific antigen testing among enrolled men means many prevalent cancers had already been removed from the population before randomisation."],"changedPractice":true,"participants":76693},"route":"/key-papers/paper-andriole-plco-prostate-screening-nejm-2009/","neighbours":{"paper":[{"id":"paper-schroder-erspc-screening-mortality-nejm-2009","kind":"paper","name":"ERSPC: screening and prostate cancer mortality in a randomised European study","route":"/key-papers/paper-schroder-erspc-screening-mortality-nejm-2009/"},{"id":"paper-catalona-psa-screening-test-nejm-1991","kind":"paper","name":"Measurement of prostate-specific antigen in serum as a screening test for prostate cancer","route":"/key-papers/paper-catalona-psa-screening-test-nejm-1991/"},{"id":"paper-martin-jama","kind":"paper","name":"Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial","route":"/key-papers/paper-martin-jama/"},{"id":"paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011","kind":"paper","name":"Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial","route":"/key-papers/paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011/"},{"id":"paper-moyer-uspstf-prostate-screening-ann-intern-med-2012","kind":"paper","name":"USPSTF 2012: screening for prostate cancer, recommendation statement (grade D)","route":"/key-papers/paper-moyer-uspstf-prostate-screening-ann-intern-med-2012/"}],"roadmap":[{"id":"early-detection-roadmap","kind":"roadmap","name":"Early detection roadmap: organ screening → blood tests for many cancers","route":"/roadmaps/early-detection-roadmap/"},{"id":"prostate-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/prostate-roadmap/"}],"cancer":[{"id":"prostate-intermediate-risk","kind":"cancer","name":"Localised prostate cancer, intermediate risk","route":"/cancers/prostate-intermediate-risk/"},{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"term":[{"id":"lead-time-bias","kind":"term","name":"Lead time, and lead-time bias","route":"/terms/lead-time-bias/"},{"id":"number-needed-to-screen","kind":"term","name":"Number needed to screen (and number needed to diagnose)","route":"/terms/number-needed-to-screen/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"screening","kind":"term","name":"Screening","route":"/terms/screening/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}