Prostate Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Evidence of Benefit
Summary of First Four Prostate, Lung, Colorectal, and Ovarian Screening Roundsa continued...
Possible harms included overdiagnosis, which was estimated at 30% on the basis of excess cases in the SA if the cumulative risk of prostate cancer had been the same as the CA.
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 were 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.