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Prostate Cancer Mortality Reduction by Prostate-Specific Antigen-Based Screening Adjusted for Nonattendance and Contamination in the European Randomised Study of Screening for Prostate Cancer (ERSPC)

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Author

  • Monique J. Roobol
  • Melissa Kerkhof
  • Fritz H. Schroeder
  • Jack Cuzick
  • Peter Sasieni
  • Matti Hakama
  • Ulf Hakan Stenman
  • Stefano Ciatto
  • Vera Nelen
  • Maciej Kwiatkowski
  • Marcos Lujan
  • Hans Lilja
  • Marco Zappa
  • Louis Denis
  • Franz Recker
  • Antonio Berenguer
  • Mirja Ruutu
  • Paula Kujala
  • Chris H. Bangma
  • Gunnar Aus
  • Teuvo L. J. Tammela
  • Arnauld Villers
  • Xavier Rebillard
  • Sue M. Moss
  • Harry J. de Koning
  • Jonas Hugosson
  • Anssi Auvinen
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Summary, in English

Background: Prostate-specific antigen (PSA) based screening for prostate cancer (PCa) has been shown to reduce prostate specific mortality by 20% in an intention to screen (ITS) analysis in a randomised trial (European Randomised Study of Screening for Prostate Cancer [ERSPC]). This effect may be diluted by nonattendance in men randomised to the screening arm and contamination in men randomised to the control arm. Objective: To assess the magnitude of the PCa-specific mortality reduction after adjustment for nonattendance and contamination. Design, setting, and participants: We analysed the occurrence of PCa deaths during an average follow-up of 9 yr in 162 243 men 55-69 yr of age randomised in seven participating centres of the ERSPC. Centres were also grouped according to the type of randomisation (ie, before or after informed written consent). Intervention: Nonattendance was defined as nonattending the initial screening round in ERSPC. The estimate of contamination was based on PSA use in controls in ERSPC Rotterdam. Measurements: Relative risks (RRs) with 95% confidence intervals (Cis) were compared between an ITS analysis and analyses adjusting for nonattendance and contamination using a statistical method developed for this purpose. Results and limitations: In the ITS analysis, the RR of PCa death in men allocated to the intervention arm relative to the control arm was 0.80 (95% CI, 0.68-0.96). Adjustment for nonattendance resulted in a RR of 0.73 (95% CI, 0.58-0.93), and additional adjustment for contamination using two different estimates led to estimated reductions of 0.69 (95% CI, 0.51-0.92) to 0.71 (95% CI, 0.55-0.93), respectively. Contamination data were obtained through extrapolation of single-centre data. No heterogeneity was found between the groups of centres. Conclusions: PSA screening reduces the risk of dying of PCa by up to 31% in men actually screened. This benefit should be weighed against a degree of over diagnosis and overtreatment inherent in PCa screening. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Publishing year

2009

Language

English

Pages

584-591

Publication/Series

European Urology

Volume

56

Issue

4

Document type

Journal article

Publisher

Elsevier

Topic

  • Urology and Nephrology

Keywords

  • Non compliance
  • Mortality reduction
  • Prostate cancer
  • Screening
  • Contamination
  • Adjusted analysis

Status

Published

Research group

  • Clinical Chemistry, Malmö

ISBN/ISSN/Other

  • ISSN: 1873-7560