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Long-Term Outcomes from a Landmark Prostate Cancer Screening Trial
The European Randomized Study of Screening for Prostate Cancer (ERSPC), with 182,000 participants, is considered the most credible of several randomized trials of prostate-specific antigen (PSA) screening for prostate cancer. Initial findings, published in 2009 after 9 years of follow-up, indicated 7 fewer prostate cancer deaths per 10,000 screened men compared with controls (NEJM JW Gen Med Apr 15 2009 and N Engl J Med 2009; 360:1310). Now, the researchers provide longer-term outcomes.
At 23 years, cumulative prostate cancer mortality was 1.4% in the screening group and 1.6% in the control group, a statistically significant difference that translates into 22 fewer prostate cancer deaths per 10,000 men. As expected in a screening study, prostate cancer was diagnosed significantly more frequently in the screening group than in the control group (14% vs. 12%).
Comment
Further improvement in prostate cancer–specific mortality with extended follow-up of ERSPC participants is reassuring. Moreover, in contemporary practice, greater use of magnetic resonance imaging and of surveillance in patients with low-grade cancers has refined our decision-making in men with elevated PSA levels. But PSA remains a flawed screening test, which the authors of this report acknowledge in their concluding statement: “Although our study has shown that PSA-based screening has been beneficial in reducing prostate cancer mortality and in increasing the favorability of the harm-versus-benefit profile over extended follow-up, the associated risks of overdiagnosis and unnecessary interventions remain considerable.”
Citation(s)
Author:
Roobol MJ et al.
Title:
European study of prostate cancer screening — 23-year follow-up.
Source:
N Engl J Med
2025
Oct
30; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Allan S. Brett, MD