Richard M. Hoffman, MD, MPH
Does population-based screening using prostate-specific antigen (PSA) testing reduce prostate cancer mortality?
Ongoing randomized controlled trial. Current Controlled Trials ISRCTN54449243.
Blinded (committee evaluating cause of death).*
Maximum 14 years.
Population-based study in Göteborg, Sweden.
20 000 randomly selected men 50 to 64 years of age. 96 men had previous prostate cancer or died or emigrated before randomization and were excluded from the analysis.
10 000 men were allocated to screening and invited for PSA testing every 2 years up to the upper age limit (mean 69 y). Further testing, including digital rectal examination, transrectal ultrasonography, and sextant biopsy, was offered to men with PSA levels ≥ 3.4 ng/mL (1995 to 1998), ≥ 2.9 ng/mL (1999 to 2004), or ≥ 2.5 ng/mL (2005 onward). 10 000 men were allocated to the control group and were not invited for screening.
Prostate cancer mortality. Other outcomes included prostate cancer incidence, obtained from Swedish cancer registries, and all-cause mortality, obtained from the Swedish population register.
> 99% (intention-to-screen analysis).
At a maximum 14 years of follow-up, 7 rounds of screening were completed, and 76% of the screening group had been screened ≥ 1 time. More participants in the screening group than the control group were diagnosed with prostate cancer, and fewer died of prostate cancer (Table). To prevent 1 additional death from prostate cancer, 293 men needed to be invited for screening and 12 needed to be diagnosed. The groups did not differ for all-cause mortality (Table).
Population-based screening using prostate-specific antigen testing reduced prostate cancer mortality and increased detection of prostate cancer.
Prostate cancer screening using prostate-specific antigen testing vs no screening in the general population†
†NNS = number needed to screen; other abbreviations defined in Glossary. RRR, RRI, NNS, and CI calculated from data reported in article (prostate cancer mortality: relative risk; prostate cancer incidence: hazard ratio and Kaplan-Meier estimate of control event rate; all-cause mortality: raw event rates).
Hoffman RM. Population-based screening using prostate-specific antigen testing reduced prostate cancer mortality. Ann Intern Med. 2010;153:JC6–9. doi: 10.7326/0003-4819-153-12-201012210-02009
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Published: Ann Intern Med. 2010;153(12):JC6-9.
Hematology/Oncology, Prostate Cancer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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