[Early detection of prostate cancer--recommendations after 13 years of follow-up in the European randomised study]

Abstract

The recent publication of updated results from the European randomised study of screening for prostate cancer (ERSPC) with a median 13-year follow-up confirms significant relative and absolute reductions in prostate cancer mortality. In spite of existing guidelines, Dutch men and professionals remain uncertain about the use of PSA testing. The data now available will be helpful in reaching informed decisions. In men aged 55-69 years, the relative mortality reduction remained similar at 21%; the absolute reduction increased from 0.9 to 1.28 fewer deaths/1000 men screened. This translates into much improved figures needing to be invited for screening and diagnosed, at 781 and 27 (1410 and 48 in 2009). As expected, overall mortality does not differ between the arms of the study. The main downside of PSA-driven screening remains the diagnosis of non-life-threatening cancers (overdiagnosis) by screening, at a frequency of about 40%, which can be reduced by use of the Prostate Cancer Risk Calculator. Current data support the present guideline which recommends informed decision-making, taking into account the advantages and potential damage caused by PSA testing.