ArticlesScreening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up
Introduction
The European Randomised study of Screening for Prostate Cancer (ERSPC) has shown significant reductions in prostate cancer mortality after 9 years1 and 11 years of follow-up.2 Despite these results, screening for prostate cancer is controversial because of adverse effects such as overdiagnosis, which is estimated to include 40–50% of screen-detected cases and often results in overtreatment with subsequent side-effects.3, 4, 5 However, a modelling study, partly based on ERSPC data, showed that with a 4-year screening interval a gain of 52 life-years and a gain of 41 quality-of-life-adjusted life-years (QALYs) was achieved per 1000 men, despite some reduction in quality of life due to overdiagnosis and long-term side-effects of treatment.5
We report updated results of mortality from prostate cancer with follow-up to 2010, with analyses truncated at 9 years, 11 years, and 13 years of follow-up. For the first time, we include France in the analysis of incidence of prostate cancer at 9 years of follow-up, but not in the analysis of mortality because of incomplete follow-up to the end of 2010.
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Study design and participants
The ERSPC is a multicentre, randomised, screening trial with the main aim to compare mortality from prostate cancer in an intervention group invited to screening with a control group with no intervention offered. The trial was initiated in 1993 in the Netherlands and in Belgium.6, 7 Five other centres (in Sweden, Finland, Italy, Spain, and Switzerland) joined the study between 1994 and 1998. Two French centres started in 2000 and 2003.
Eligible participants were men aged 50–74 years at the time
Results
In the core group of men aged 55–69 years, excluding France, 162 388 were randomly assigned, of whom 145 died between randomisation and screening. With data truncated at 13 years of follow-up, 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group (figure 1).
The median age at randomisation was 60·2 years (table 1). The overall compliance with biopsies was 85·6%, 20 188 of 23 574 screen-positive tests. On average, men in the intervention group
Discussion
The results of our primary analysis, based on extended follow-up up to 13 years, showed no further increase in the relative effect of screening on prostate cancer mortality after 11 years,2 but an enhanced absolute mortality reduction per 1000 men randomised (panel). In line with ERSPC rules of participation and reporting,8 France was included in the analysis of incidence, but not in that of mortality, because of incomplete follow-up to the end of 2010. The absolute effect—ie, absolute risk
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