Randomized study of PSA testing for prostate cancer – 23-year follow-up

The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in 1993 to assess the effect of PSA testing on prostate cancer mortality. The study, conducted across eight European countries, randomized 162,236 men who were aged 55 to 69 years at the time of randomization to screening or control. 23-year follow-up of ERSPC have now been published. Prostate cancer mortality was 13% lower in the screening group than in the control group (Rate ratio 0.87; 95% CI 0.80-0.95), and the absolute risk reduction was 0.22% (0.10-0.34). The cumulative incidence of prostate cancer was higher in the screening group than in the control group (RR 1.31: 95%CI 1.26-1.33). At a median 23 years of follow-up, one death from prostate cancer was prevented for every 456 men (95% CI 306-943) who were invited for screening, and one death from prostate cancer was averted for every 12 men (95% CI 8-26) in whom prostate cancer was diagnosed, as compared with one death from prostate cancer prevented for every 628 men (419-1481) and one death averted for every 18 men (12-45) at 16 years of follow-up. The authors conclude that long-term follow-up confirms a sustained reduction in deaths from prostate cancer with PSA testing, alongside an improved harm-benefit ratio (quick take video summary).