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Letters |17 April 2018

Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials

Shinkan Tokudome, MD; Ryosuke Ando, MD; Shuji Hashimoto, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • Laboratory of Cancer Epidemiology and Prevention, Nisshin, Japan (S.T.)
    Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (R.A.)
    Fujita Health University School of Medicine, Toyoake, Japan (S.H.)

    Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0737.

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TO THE EDITOR:
Tsodikov and colleagues (1) seem to have resolved a long-standing controversy about the effectiveness of PSA-based screening for mortality reduction in prostate cancer—namely, the discrepancy between the ERSPC (2) and PLCO (3). They did so by applying the same analysis method (Cox regression analysis) to MLTs. Screening translated to an estimated prostate cancer mortality reduction between 25% and 31% in the ERSPC population and 27% and 32% in the PLCO population compared with no screening.
Insufficient statistical power of the ERSPC was salvaged by extending the observation period to 11 years to increase the number of deaths in the analysis. However, whether the alleged contamination bias in the PLCO was adequately controlled for is debatable, because systematic error can be remedied only before a study is launched. Discussion specifically remains on whether the sophisticated analysis of MLTs has been validated against a conventional survival analysis.
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Tokudome S, Ando R, Hashimoto S. Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials. Ann Intern Med. ;168:608. doi: 10.7326/L17-0737

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© 2019

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Published: Ann Intern Med. 2018;168(8):608.

DOI: 10.7326/L17-0737

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2018 American College of Physicians
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