Prostate Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Evidence of Benefit
Summary of First Four Prostate, Lung, Colorectal, and Ovarian Screening Roundsa continued...
The Goteborg (Sweden) trial is a prospective randomized trial of 20,000 men born between 1930 and 1944. Data from participants born between 1930 and 1939 is used in the pooled ERSPC data. Recently, data with up to 14 years of follow-up was reported. Of the screened group, 12.7% was diagnosed with prostate cancer versus 8.2% of the control group. The absolute risk of prostate death was 0.9% in the control group and 0.5% in the screening group (95% CI, 0.17–0.64). This is a 44% RR reduction in prostate-cancer mortality (95% CI, 0.28–0.68; P = .0002). Of note, the number of deaths from all causes was equal in the intervention group and the control group. The authors estimated that 12 men needed to be diagnosed and treated to prevent one death.
The Norrkoping study (Sweden) is a population-based nonrandomized trial of prostate cancer screening. All men aged 50 to 69 years living in Norrkoping, Sweden in 1987 were allocated to either invited (every sixth man allocated to invited group) or not-invited groups. The 1,494 men in the invited group were offered screening every 3 years from 1987 to 1996. The first two rounds were by DRE; the last two rounds by both DRE and PSA. About 85% of men in the invited group attended at least one screening; contamination by screening in the not-invited group (n = 7,532) was thought to be low. After 20 years of follow-up, the invited group had a 46% relative increase in prostate cancer diagnosis. Over the period of the study, 30 men (2%) in the invited group died of prostate cancer, compared with 130 (1.7%) men in the not-invited group. The RR of prostate cancer mortality was 1.16 (95% CI, 0.78–1.73). This nonstatistically significant finding provides no evidence that screening leads to a reduction in prostate cancer mortality, even after 20 years of follow-up.
Because the efficacy of screening depends on the effectiveness of management of screen-detected lesions, trials of treatment efficacy in early-stage disease are relevant to the issue of screening. The Prostate Intervention Versus Observation Trial (PIVOT) is the only published trial conducted in the PSA era that directly compared radical prostatectomy with watchful waiting. From November 1994 through January 2002, 731 men aged 75 years or younger with localized prostate cancer were randomly assigned to one of the two management strategies. About 50% of the men had nonpalpable, screen-detected disease. After a median follow-up of 10 years (maximum up to about 15 years), there was no statistically significant difference in overall or prostate-specific mortality. (Refer to the Treatment Option Overview section in the PDQ summary on Prostate Cancer Treatment for a more detailed description of the study and results.)