Screening and prostate-cancer mortality in a randomized European study

Making Education Easy

Authors:

Schröder FH et al

August 17, 2009

Summary:

Data are reported from the European Randomized Study of Screening for Prostate Cancer (ERSPC), initiated in the early 1990s to evaluate the effect of screening with prostatespecific- antigen (PSA) testing on death rates from prostate cancer. 182,000 men aged 50–74 years were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. PSA screening was associated with a 20% reduction in the rate of death from prostate cancer. The study showed an absolute reduction of approximately 7 prostate-cancer-related deaths per 10,000 men screened.

Comment:

Screening for prostate cancer is a controversial issue, and these two articles provide much anticipated evidence from large trials. Taken together, they suggest that the effect of screening on prostate cancer mortality is modest at best. However, as the accompanying editorial states, the key question is not whether prostate screening is effective but whether it does more good than harm. In fact, any benefit comes at the cost of substantial overdiagnosis and overtreatment, which leads to adverse health outcomes. There tends to be a public perception that screening programmes are overwhelmingly a good thing – many people are not fully aware of the potential for harm. Decisions about whether to introduce screening programmes always need to carefully balance the risks and benefits. It seems that, at the present time anyway, there is not enough evidence to recommend a population-based prostate cancer screening programme in New Zealand.

Reference: New Engl J Med. 2009;360(13):1320-8.

Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

Screening and prostate-cancer mortality in a randomized European study

Independent commentary by Dr. Matire Hardwood

Related Articles

Explore Māori Health Reviews

Screening and prostate-cancer mortality in a randomized European study

Independent commentary by Dr. Matire Hardwood

Related Articles

Explore Māori Health Reviews

Find Reviews in Your Clinical Area

Terms and Conditions