AUA 2013: ERSPC: PSA screening cuts prostate cancer deaths by 32%

New evidence from the European Randomized Study of Screening for Prostate Cancer (ERSPC) suggests that prostate cancer screening is beneficial, particularly in the core age group of 55 to 69 years.

“These new data show that systematic PSA-based screening reduces prostate cancer-specific mortality by 32% in the age range of 55 to 69 years. Starting screening in men over 70 years is, however, ineffective,” said first author Monique J. Roobol, PhD, of Erasmus University Medical Center, Rotterdam, the Netherlands, who worked on the analysis with the ERSPC Study Group.

Investigators invited 88,283 men ages 54 to 74 years to enter the trial from 1993 to 1999. Active screening is still ongoing. The 42,376 men (34,833 men age 55-69 years, core age group) who gave their informed consent were then randomized into either the screening arm (21,210 men) or control arm (21,166 men).

After a median follow-up of 12.8 years, investigators screened 19,765 men (94.2%) at least once and detected 2,674 cases of prostate cancer, of which 561 (21%) were interval prostate cancers (those that emerge between two screenings). The positive predictive value (PPV) of PSA 3.0 ng/mL or higher was about 20% and stable over the four screening rounds. The overall cancer detection rate in the 21,210 men who were screened was 10.1%, which rose to 12.7% when including interval prostate cancer and prostate cancer diagnosed after age 74.

The PPV for PSA ≥10.0 ng/mL declined after the first screening, while the PPV in the PSA range of 3.0 to 9.9 ng/mL remained fairly constant. The rate of prostate cancer detected in the control arm was 6.8% (1,430 men), resulting in an excess incidence of 59 cases of prostate cancer per 1,000 men randomized (61 prostate cancers per 1,000 in the 55-69 year age group).