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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.
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.
The 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.
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.
One technology page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
The clearest case in cancer screening of a national body acting on the harms rather than the headline. Whether it was right is still argued: testing and localised-stage diagnosis fell, and the long-term effect on metastatic presentation and mortality is the subject of the studies that followed.
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.
The paper that made opportunistic prostate-specific antigen testing routine, and the source of the threshold still printed on laboratory reports. Everything in the overdiagnosis literature is, in effect, an audit of what this recommendation did when it was applied to whole populations.
Shares Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial, Lead time, and lead-time bias, Number needed to screen (and number needed to diagnose), ERSPC: screening and prostate cancer mortality in a randomised European study and the tag prostate-evidence.
Shares Lead time, and lead-time bias, Number needed to screen (and number needed to diagnose), ERSPC: screening and prostate cancer mortality in a randomised European study, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Measurement of prostate-specific antigen in serum as a screening test for prostate cancer, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares USPSTF 2012: screening for prostate cancer, recommendation statement (grade D), Number needed to screen (and number needed to diagnose), PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk and the tag prostate-evidence.
Shares Lead time, and lead-time bias, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Screening and the tag prostate-evidence.
Shares Lead time, and lead-time bias, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Screening and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Screening and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Overdiagnosis and false alarms and the tag prostate-evidence.