Evidence of Benefit
Summary of First Four Prostate, Lung, Colorectal, and Ovarian Screening Roundsa continued...
Prostate cancer mortality data from the PLCO cancer screening trial after 13 years of follow-up show no reduction in mortality due to prostate cancer screening with PSA and DRE. Organized screening in the intervention arm of the trial did not produce a mortality reduction compared with opportunistic screening in the control arm. There were no apparent interactions with age, baseline comorbidity, or pre-trial PSA testing as hypothesized in an intervening analysis by a subgroup analysis. These results are consistent with the prior report at 7 to 10 years of follow-up described above. The update accounts for 76,685 men, aged 55 to 74 years, enrolled at 10 screening centers between November 1993 and July 2001 who were randomly assigned to annual PSA screening for 6 years and DRE for 4 years (38,340 men) or usual care (38,345 men), which sometimes included opportunistic screening in the local communities. All prostate cancer incidents and deaths through 13 years of follow-up or through December 31, 2009 were ascertained.
The 13-year follow-up analysis reports 45% of men in the PLCO trial had at least one PSA test in the 3 years prior to randomization. PSA screening in the usual care arm was estimated to be as high as 52% by the end of the screening period. The intensity of PSA screening in the usual care arm was estimated to be half that in the intervention arm. Stage-specific treatment between the two arms was similar.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in the early 1990s to evaluate the effect of screening with PSA testing on death rates from prostate cancer. Through registries in seven European countries, investigators identified 182,000 men between the ages of 50 and 74 years for inclusion in the study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006.