ERSPC: PSA screening cuts PCa deaths by one-fifth

Recently published data from the European Randomised Study of Screening for Prostate Cancer (ERSPC) indicate that screening for prostate cancer could reduce deaths from the disease by about one-fifth.

However, the study’s authors do not recommend the introduction of routine PSA screening because doubts about whether the benefits of screening outweigh the harms remain.

The ERSPC began in 1993 to determine whether screening men for PSA reduces deaths from prostate cancer. It recruited men between the ages of 50 and 74 years from eight countries who were randomized to receive either PSA screening every 4 years (2 years in Sweden) or no intervention (control group). Men were referred for biopsy if their PSA concentration was higher than 3.0 ng/mL.

The results, published online in The Lancet (Aug. 7, 2014), showed that screening appeared to reduce prostate cancer deaths by 15% at 9 years, and this improved to 22% at 11 years. Over 13 years’ follow-up, there was no further improvement in the relative reduction in prostate cancer deaths, which decreased by 21% in the screening group compared with the control group, although men who were actually screened had a 27% lower chance of dying of prostate cancer.

However, the absolute benefit of screening steadily increased with longer follow-up. The number of men needed to be invited for screening to prevent one death from prostate cancer dropped from 1,410 after 9 years of follow-up to 781 at 13 years. The number needed to be diagnosed and treated to prevent one prostate cancer death also fell from 48 to 27. The risk of advanced prostate cancer was also smaller in the screening group.

According to study leader Fritz Schröder, MD, of Erasmus University Medical Center, Amsterdam, the Netherlands, "PSA screening delivers a substantial reduction in prostate cancer deaths, similar or greater than that reported in screening for breast cancer. However, over-diagnosis occurs in roughly 40% of cases detected by screening, resulting in a high risk of overtreatment and common side effects such as incontinence and impotence.

Next: "The time for population-based screening has not arrived."

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"The time for population-based screening has not arrived,” Dr. Schröder added. He called for further research on ways to reduce over diagnosis, including the use of multiparametric magnetic resonance imaging technology.

In a comment also published online in The Lancet (Aug. 7, 2014), Ian Thompson, MD, of the University of Texas Health Science Center, San Antonio, and Catherine Tangen, DrPH, of Fred Hutchinson Cancer Research Center, Seattle, called the new findings “crucially important.”

“In future publications from the study, the distribution of prostate cancer deaths by Gleason score and PSA at diagnosis will be important to understand how to tailor screening and treatment,” Dr. Thompson and Dr. Tangen wrote.