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A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer

Journal article
Authors Jonas Hugosson
M. J. Roobol
Marianne Månsson
T. L. J. Tammela
M. Zappa
V. Nelen
M. Kwiatkowski
M. Lujan
Sigrid Carlsson
K. M. Talala
H. Lilja
L. J. Denis
F. Recker
A. Paez
D. Puliti
A. Villers
X. Rebillard
T. P. Kilpelainen
U. H. Stenman
Rebecka Arnsrud Godtman
Karin Stinesen-Kollberg
S. M. Moss
P. Kujala
K. Taari
A. Huber
T. van der Kwast
E. A. Heijnsdijk
C. Bangma
H. J. De Koning
F. H. Schroder
A. Auvinen
Published in European Urology
Volume 76
Issue 1
Pages 43-51
ISSN 0302-2838
Publication year 2019
Published at Institute of Clinical Sciences, Department of Urology
Pages 43-51
Language en
Keywords Prostate cancer, Screening, Prostate-specific antigen, Mortality, mortality, erspc, death, risk, Urology & Nephrology, mets dl, 1994, statistics in medicine, v13, p1341
Subject categories Urology and Nephrology


Background: The European Randomized study of Screening for Prostate Cancer (ERSPC) has previously demonstrated that prostate-specific antigen (PSA) screening decreases prostate cancer (PCa) mortality. Objective: To determine whether PSA screening decreases PCa mortality for up to 16 yr and to assess results following adjustment for nonparticipation and the number of screening rounds attended. Design, setting, and participants: This multicentre population-based randomised screening trial was conducted in eight European countries. Report includes 182 160 men, followed up until 2014 (maximum of 16 yr), with a predefined core age group of 162 389 men (55-69 yr), selected from population registry. Outcome measurements and statistical analysis: The outcome was PCa mortality, also assessed with adjustment for nonparticipation and the number of screening rounds attended. Results and limitations: The rate ratio of PCa mortality was 0.80 (95% confidence interval [CI] 0.72-0.89, p < 0.001) at 16 yr. The difference in absolute PCa mortality increased from 0.14% at 13 yr to 0.18% at 16 yr. The number of men needed to be invited for screening to prevent one PCa death was 570 at 16 yr compared with 742 at 13 yr. The number needed to diagnose was reduced to 18 from 26 at 13 yr. Men with PCa detected during the first round had a higher prevalence of PSA >20 ng/ml (9.9% compared with 4.1% in the second round, p < 0.001) and higher PCa mortality (hazard ratio = 1.86, p < 0.001) than those detected subsequently. Conclusions: Findings corroborate earlier results that PSA screening significantly reduces PCa mortality, showing larger absolute benefit with longer follow-up and a reduction in excess incidence. Repeated screening may be important to reduce PCa mortality on a population level. Patient summary: In this report, we looked at the outcomes from prostate cancer in a large European population. We found that repeated screening reduces the risk of dying from prostate cancer. (C) 2019 Published by Elsevier B.V. on behalf of European Association of Urology.

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