The Science and Art of Prostate Cancer Screening

Extract

Despite the clinical availability of prostate-specific antigen (PSA) screening for nearly a quarter of a century, there are still differences of opinion as to whether such screening is worthwhile. In an attempt to directly address this controversy, early results from two large randomized trials were published in 2009 ( 1 , 2 ). The European Randomized Study of Screening for Prostate Cancer (ERSPC) was a combined analysis of prospective randomized European trials consisting of a total of 162 243 subjects aged 55–69 years who were screened or observed at intervals up to 4 years and recommended for biopsies when the PSA levels were elevated (primarily ≥3.0 ng/mL) ( 1 ). The Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) study enrolled 76 693 men aged 55–74 years but screened them on an annual basis and recommended biopsies for PSA levels greater than 4.0 ng/mL ( 2 ). The ERSPC study showed a 20% relative reduction in prostate cancer mortality (rate ratio = 0.80, 95% confidence interval = 0.65 to 0.98, P = .04) ( 1 ) in the screened group, whereas the PLCO study did not show any statistically significant change in prostate cancer mortality (rate ratio = 1.13, 95% confidence interval = 0.75 to 1.70) ( 2 ).