European study: PSA screening reduces mortality up to 31%

PSA screening has reduced prostate cancer mortality up to 31%, according to findings from the European Randomized Study of Screening for Prostate Cancer (ERSPC).

Preliminary findings from the ERSPC had already shown screening reduced prostate cancer deaths by 20% (N Engl J Med 2009; 360:1320-8). This latest analysis corrects for non-attendance and contamination to assess the effectiveness of PSA testing in those men actually screened.

From 1992, the ERSPC study randomized 162,000 men, aged 55 to 69 years, in seven European countries to either a screening or a control group. Those who were screened were given a blood test to detect PSA levels: if PSA was 3.0 ng/mL or more, they were offered a biopsy. Screening took place on average every 4 years. Mean follow-up was 9 years.

Using retrospective data from the Dutch arm of the study, the ERSPC has shown that using a screening algorithm alongside PSA testing can reduce the number of unnecessary biopsies. The findings, to be published in European Urology (January 2010), suggest that a PSA cutoff level of 3.0 ng/mL, combined with an individual risk assessment, would reduce biopsies by 33%.

The majority of cancers potentially missed would be indolent, so there would be no benefit from active treatment. Increasing the PSA cutoff level from 3.0 ng/mL to 4.0 ng/mL may save a similar number of biopsies, but will miss more clinically significant cancers, according to the researchers, led by Monique J. Roobol, PhD of Erasmus Medical Center, Rotterdam, the Netherlands.