Another Study of Prostate-Specific Antigen Screening;

Wednesday, 04/08/2010  |   Prostate Cancer  |  1 comment

Another Study of Prostate-Specific Antigen Screening; In a Swedish trial, screening was associated with an absolute reduction of 0.4% in prostate cancer mortality.
Last year, conflicting results from two trials of prostate cancer screening were published: The European ERSPC showed a barely significant absolute reduction in prostate cancer mortality, and the U.S. PLCO showed no benefit from screening. Now a randomised trial from Sweden, it originally was designed independently from the ERSPC, but eventually, 60% of its participants were included in the ERSPC.
In 1994, 32,000 men aged 50 to 64 lived in Göteborg, Sweden; 20,000 of these men were randomly selected and randomly assigned to receive either prostate-specific antigen (PSA) screening every 2 years or no screening; 76% of screening invitees accepted. Initially, a PSA cutoff level of 3.4 ng/mL prompted further evaluation, but this threshold later was lowered to 2.5 ng/mL.
During median follow-up of 14 years, prostate cancer was diagnosed significantly more often in the screening group than in the control group (12.7% vs. 8.2%). The incidence of death from prostate cancer was significantly lower in the screening group than in controls (0.5% vs. 0.9%; P=0.002); however, overall mortality was identical in the groups (19.9%). Investigators who assigned cause of death were blinded to whether deceased patients had been screened.
In this study, screening was associated with lower prostate cancer–specific mortality but no change in overall mortality. Strengths of the study are its population-based design and a longer average follow-up than that provided in the ERSPC and PLCO trials. Nonetheless, over-diagnosis and over-treatment continue to be vexing problems associated with prostate cancer screening and note the age of the cohort. After 16 years the youngest member would be 66 and the oldest 80 years old

Hugosson, J., Carlsson, S., Aus, G., Bergdahi, S., Khatami, A., Lodding, P., Pihl, C-G., Stranne, J., Holmberg, E. & Lilja, H. Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Lancet Oncol 2010 Aug; 11:725. (http://dx.doi.org/10.1016/S1470-2045(10)70146-7)

One Comment

  1. giselle schnepfensiefen
    Aug 10, 2010

    Daniel,
    I have been following your blog for some time and
    I want to say how impressed I am with this work.
    It has been very helpful in my clinic
    thank you

    giselle

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