Screening for Prostate Cancer: Results of the Rotterdam Section of the European Randomized Study of Screening for Prostate Cancer

Monique Roobol - Bouts, M Kranse, CH Bangma VERVALLEN, Arno van Leenders, BG Blijenberg, Ron van Schaik, WJ (Wim) Kirkels, Suzie Otto, Theodorus Kwast, Harry de Koning, Fritz Schröder

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Abstract

Background: Evidence from randomized trials on the effects of screening for prostate cancer (PCa) on disease-specific mortality accumulates slowly with increasing follow-up. Objective: To assess data on PCa-specific mortality in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial. Design, setting, and participants: A randomized controlled trial with randomization after signed, written informed consent (efficacy trial). In the period 1993-1999, a total of 42 376 men aged 54-74 yr were randomized to a screening arm (S-arm) (n = 21 210 with screening every 4 yr, applying a total prostate-specific antigen [PSA] level cut-off >= 3.0 ng/ml as biopsy indication) or a control arm (C-arm) (n = 21 166; no intervention). Outcome measurements and statistical analysis: Number of PCas detected per arm depicted by predefined time periods and prognostic groups. PCa-specific mortality analyses using Poisson regression in age group 55-74 yr at randomization and separately in the predefined age group of 55-69 yr. Results and limitations: After a median follow-up of 12.8 yr, 19 765 men (94.2%) were screened at least once and 2674 PCas were detected (of which 561 [21.0%] were interval PCas). In the C-arm, 1430 PCas were detected, resulting in an excess incidence of 59 PCas per 1000 men randomized (61 PCas per 1000 in age group 55-69 yr). Thirty-two percent of all men randomized have died. PCa-specific mortality relative-risk (RR) reductions of 20.0% overall (age: 55-74 yr; p = 0.042) and 31.6% (age: 55-69 Conclusions: Systematic PSA-based screening reduced PCa-specific mortality by 32% in the age range of 55-69 yr. The roughly twofold higher incidence in the S-arm underlines the importance of tools to better identify those men who would benefit from screening. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)530-539
Number of pages10
JournalEuropean Urology
Volume64
Issue number4
DOIs
Publication statusPublished - 2013

Research programs

  • EMC MM-03-24-01
  • EMC MM-03-49-01
  • EMC NIHES-02-65-01

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