Screening Reduces Risk of Prostate Cancer Mortality

No differences in the effects of screening versus no screening found between 2 prostate cancer trials.

In 2009, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) provided sufficient evidence on the efficacy of prostate-specific antigen (PSA) screening for the first time.

Despite this, the findings appeared contradictory with low rates of prostate cancer death that did not significantly differ between groups in the PLCO study versus findings from ERSPC that suggest screening reduced prostate cancer mortality by 20%.

The United States Preventive Services Task Force recommends against PSA screening for prostate cancer because evidence showed very low probability that it would reduce the risk of dying from prostate cancer.

In a study published in Annals of Internal Medicine, investigators sought to evaluate whether the effects of screening on prostate cancer mortality versus no screening differed between the ERSPC and the PLCO.

They used a mathematical model to account for differences in implementation, compliance, and practice settings. The results of the study showed no evidence that the effects of screening compared with no screening differed between ERSPC and PLCO.

Screening was estimated to confer a 7% to 9% reduction in the risk of prostate cancer death per year of mean lead times. This translates to a 25% to 31% lower risk of prostate cancer death with screening compared with a 27% to 32% lower risk of prostate cancer death with no screening.

A limitation to the study was mean lead times involves a simple metric of screening and diagnostic work-up, according to the authors.

“After differences in implementation and settings are accounted for, the ERSPC and PLCO provide compatible evidence that screening reduces prostate cancer mortality,” the authors concluded.

Prostate cancer is the third leading cause of cancer death in American men, following lung cancer and colorectal cancer, according to the American Cancer Society. The disease typically develops in older men, and approximately 1 of every 7 men will be diagnosed with prostate cancer during his lifetime.