Prostate Cancer Screening: The Need For Problem-Solving that Puts Men's Interests First

Screening for prostate cancer---the controversy continues, but can it be resolved?

BACKGROUND

In 2009, the European Randomized Study of Screening for Prostate Cancer (ERSPC) was one of two studies to report interim data on the effect of screening for prostate cancer (PC) on the disease specific mortality. Contradictory results caused considerable discussion and misunderstanding in secondary literature.

METHODS

This document is based on a non systematic review of recent evidence for and against screening for PC, specifically considering three recently published randomized screening trials [ 1-3 ].

RESULTS

The ERSPC data are based on a core age group of 162 387 men, aged 55-69 years, who were identified through population registries in seven European countries. Men were randomized between a screening group that received screening at an average of once every four years and a control group. After a median follow-up of nine years, a reduction in the rate of death from PC by 20% was shown which increased to 31% after adjusting for non-compliance and contamination. Overdetection and subsequent overtreatment (with a number needed to treat (NNT) of 48) are considered to be the major down sides of screening. The recently published 14-year results have shown that these down sides strongly depend on the duration of follow-up. In response to the outcomes of the ERSPC, several points of discussion have been brought up by various authors concerning the usefulness of screening considering benefits, harms and costs, the methodology of the ERSPC and the interpretation of its outcomes. Important issues to address regarding PC screening are addressed.

CONCLUSIONS

This paper sheds a light on the controversial points of the ERSPC as well as on the priority issues of PC screening. On July 2, 2010 the Swedish section of ERSPC (Göteborg screening trial) published their results with a median follow-up of 14 years. With longer follow-up the data confirm the trend seen in improvement of PC mortality and suggest much more favorable future outcomes also with respect to the NNT to prevent one PC death.

Prostate cancer: to screen or not to screen?

The debate about the usefulness of population-based prostate cancer screening has been ongoing for decades. The most current evidence shows limited benefit of population screening, and significant psychological, physical and financial costs. Efforts to improve screening with better markers and more selective treatment may make population-based screening more effective.