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. 2016 Jan 1;22(1):243-9.
doi: 10.1158/1078-0432.CCR-15-0941. Epub 2015 Aug 19.

Absolute Effect of Prostate Cancer Screening: Balance of Benefits and Harms by Center within the European Randomized Study of Prostate Cancer Screening

Anssi Auvinen  1 , Sue M Moss  2 , Teuvo L J Tammela  3 , Kimmo Taari  4 , Monique J Roobol  5 , Fritz H Schröder  5 , Chris H Bangma  5 , Sigrid Carlsson  6 , Gunnar Aus  7 , Marco Zappa  8 , Donella Puliti  8 , Louis J Denis  9 , Vera Nelen  9 , Maciej Kwiatkowski  10 , Marco Randazzo  11 , Alvaro Paez  12 , Marcos Lujan  13 , Jonas Hugosson  7
Affiliations

Absolute Effect of Prostate Cancer Screening: Balance of Benefits and Harms by Center within the European Randomized Study of Prostate Cancer Screening

Anssi Auvinen et al. Clin Cancer Res. .

Erratum in

Abstract

Purpose: The balance of benefits and harms in prostate cancer screening has not been sufficiently characterized. We related indicators of mortality reduction and overdetection by center within the European Randomized Study of Prostate Cancer Screening (ERSPC).

Experimental design: We analyzed the absolute mortality reduction expressed as number needed to invite (NNI = 1/absolute risk reduction; indicating how many men had to be randomized to screening arm to avert a prostate cancer death) for screening and the absolute excess of prostate cancer detection as number needed for overdetection (NNO = 1/absolute excess incidence; indicating the number of men invited per additional prostate cancer case), and compared their relationship across the seven ERSPC centers.

Results: Both absolute mortality reduction (NNI) and absolute overdetection (NNO) varied widely between the centers: NNI, 200-7,000 and NNO, 16-69. Extent of overdiagnosis and mortality reduction was closely associated [correlation coefficient, r = 0.76; weighted linear regression coefficient, β = 33; 95% confidence interval (CI), 5-62; R(2) = 0.72]. For an averted prostate cancer death at 13 years of follow-up, 12 to 36 excess cases had to be detected in various centers.

Conclusions: The differences between the ERSPC centers likely reflect variations in prostate cancer incidence and mortality, as well as in screening protocol and performance. The strong interrelation between the benefits and harms suggests that efforts to maximize the mortality effect are bound to increase overdiagnosis and might be improved by focusing on high-risk populations. The optimal balance between screening intensity and risk of overdiagnosis remains unclear.

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Conflict of interest statement

Disclosure of Potential Conflicts of Interest: Dr Auvinen reports serving as paid consultant for Epid Research. Dr. Tammela reports serving as a board member for Astellas, Amgen, Pfizer, and GlaxoSmith-Kline, receiving consulting fees from Orion Pharma, receiving lecture fees from Astellas and Amgen, receiving payment for developing educational presentations from GlaxoSmithKline, and receiving travel support from Amgen; Dr. Taari, receiving consulting fees from Astellas, GlaxoSmithKline, Ferring, and Amgen, receiving grant support from Amgen, receiving lecture fees from GlaxoSmithKline, being an employee of Medivation, and receiving travel support from Sanofi-Aventis, Pfizer, and Astellas; Dr. Schröder receiving consulting fees from GlaxoSmithKline and Ferring, and receiving lecture fees and travel support from GlaxoSmithKline, Ferring, Société International d'Urologie, and the European Association of Urology; Dr. Aus receiving lecture fees from AstraZeneca; and Dr. Kwiatkowski receiving consulting fees from GlaxoSmithKline. All other authors declare no competing interests. The authors are solely responsible for the study design, collection, analysis, and interpretation of the data, writing the report and decision to submit for publication.

Figures

Figure 1
Figure 1
Flow chart of the ERSPC trial
Figure 2
Figure 2
Number needed for overdetection The relationship between absolute prostate cancer mortality reduction, expressed as number needed to invite (NNI = 1/risk difference) and absolute excess of cumulative prostate cancer incidence, expressed as number needed for overdetection (NNO = 1/risk difference) by center in the ERSPC.
See this image and copyright information in PMC

References

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