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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.
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.
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.
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.
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 reference for anyone quoting an overdiagnosis figure in prostate cancer. The honest statement is a range with its definition and its population attached, and the paper is the reason this page does not print one number.
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.
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 USPSTF 2012: screening for prostate cancer, recommendation statement (grade D), Number needed to screen (and number needed to diagnose), Judge a prostate screening programme on metastatic presentation, not on incidence or mortality, Overdiagnosis 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 Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context, Lead time, and lead-time bias, Judge a prostate screening programme on metastatic presentation, not on incidence or mortality, Overdiagnosis and the tag prostate-evidence.
Shares Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context, Lead time, and lead-time bias, Overdiagnosis, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only, PSA and MRI-first prostate cancer screening, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk and the tag prostate-evidence.
Shares Overdiagnosis, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares Overdiagnosis, Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk, Overdiagnosis and false alarms and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk, Localised prostate cancer, high and very high risk and the tag prostate-evidence.