Prostate cancer screening could cut deaths by 20%
23 March 2009
Screening for prostate cancer can reduce deaths by 20%, according to
the results of the European Randomized Study of Screening for Prostate
Cancer (ERSPC). ERSPC is the world's largest prostate cancer screening
study and provides robust, independently-audited evidence, for the first
time, of the effect of screening on prostate cancer mortality.
The study commenced in the early 1990s involving eight countries —
Belgium, Finland, France, Italy, Netherlands, Spain, Sweden and
Switzerland — with an overall follow-up of up to 12 years. Participants
totalled 182,000 but then narrowed down to 162,000 men in seven
countries, aged 55-69; only those who had not been screened could take
The findings were unveiled at the annual European Urology Congress in
Stockholm, Sweden (17-21 March 2009) and are published in the 18 March
edition of the New England Journal of Medicine. A second early-stage
study published in the same issue gives conflicting data (See MTB Europe
story: Mixed messages from prostate cancer
By initially screening men 55 to 69 years with the PSA marker and
offering regular follow up, this led to an increase in early detection.
Deaths due to metastasized disease were then reduced. Exact data showed
that on average for every 1,408 men screened, 48 had cancer diagnosed
and received treatment, resulting in saving one life. Screening took
place on average every four years with a mean follow-up over nine years.
The cut-off value was a PSA level of 3.0 ng/ml or more. Men with this
reading were then offered a biopsy.
Prof Fritz Schroder, international coordinator of the ERSPC study
explained: "The study shows that PSA screening delivers a 20% reduction
in mortality from prostate cancer. This provides decision makers on
screening policies with important new data on the effectiveness of PSA
testing in preventing deaths.
"However, The ERSPC is also near to completing additional studies on
quality of life and cost-effectiveness and these must be assessed before
making a decision about the appropriateness of a national prostate
Worldwide, prostate cancer is the second leading cause of cancer
death. Separate ERSPC findings already confirm that approximately 30% of
detected cancers actually have non-aggressive features and are
'indolent' or slow growing.
This overdiagnosis is an unavoidable effect from all cancer screening
procedures. With prostate cancer, a new, more conservative form of
monitoring, 'Active Surveillance', might be an important method to help
avoid early invasive treatment (www.erspc.org ).
1. Fritz H Schröder, et al. Screening and Prostate-Cancer
Mortality in a Randomized European Study. New England Journal of
Medicine, 18 March 2009.
See also MTB Europe story: Mixed messages from
prostate cancer screening studies
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