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Randomized Controlled Trial
. 2012 Sep;19(3):133-40.
doi: 10.1258/jms.2012.012071.

Efficacy versus effectiveness study design within the European screening trial for prostate cancer: consequences for cancer incidence, overall mortality and cancer-specific mortality

Xiaoye Zhu  1 , Pim J van Leeuwen, Erik Holmberg, Meelan Bul, Sigrid Carlsson, Fritz H Schröder, Monique J Roobol, Jonas Hugosson
Affiliations
Randomized Controlled Trial

Efficacy versus effectiveness study design within the European screening trial for prostate cancer: consequences for cancer incidence, overall mortality and cancer-specific mortality

Xiaoye Zhu et al. J Med Screen. 2012 Sep.

Abstract

Objective: To assess the impact of different study designs on outcome data within the European Randomized Study of Screening for Prostate Cancer (ERSPC).

Methods: Observed data from the Gothenburg centre (effectiveness trial with upfront randomization before informed consent) and the Rotterdam centre (efficacy trial with randomization after informed consent) were compared with expected data, which were retrieved from national cancer registries and life tables. Endpoints were 11-year cumulative prostate cancer (PC) incidence, overall mortality and PC-specific mortality.

Results: In Gothenburg, the 11-year PC incidence was higher than predicted (5.8%) in both the intervention (12.4%) and control arms (7.3%). The observed overall mortality was higher than predicted (15.9%) in both the intervention (17.8%) and control arms (18.5%). The observed PC-specific mortality in the intervention arm was 0.56% versus 0.83% in the control arm, while the expected mortality was 0.83%. In Rotterdam, the observed PC incidence in the intervention arm (10.4%) was higher than expected (4.4%). The incidence in the control arm was 4.6%. The observed overall mortality was lower than expected: 13.6% in the intervention arm and 14.0% in the control arm versus an expected mortality of 16.1%. The observed PC-specific mortality was lower than expected (0.65%) in both the intervention (0.27%) and control arms (0.41%).

Conclusions: Our results suggest that an efficacy trial with informed consent prior to randomization may have introduced a 'healthy screenee bias'. Therefore, an effectiveness trial with consent after randomization may more accurately estimate the PC-specific mortality reduction if population-based screening is introduced.

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Figures

Figure 1
Figure 1. Flowchart of the observed data
Figure 2
Figure 2
A. Observed and expected prostate cancer incidence Gothenburg B. Observed and expected prostate cancer incidence Rotterdam
Figure 2
Figure 2
A. Observed and expected prostate cancer incidence Gothenburg B. Observed and expected prostate cancer incidence Rotterdam
Figure 3
Figure 3
A. Observed and expected overall mortality Gothenburg B. Observed and expected overall mortality Rotterdam
Figure 3
Figure 3
A. Observed and expected overall mortality Gothenburg B. Observed and expected overall mortality Rotterdam
Figure 4
Figure 4
A. Observed and expected prostate cancer-specific mortality Gothenburg B. Observed and expected prostate cancer-specific mortality Rotterdam
Figure 4
Figure 4
A. Observed and expected prostate cancer-specific mortality Gothenburg B. Observed and expected prostate cancer-specific mortality Rotterdam
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