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Randomized Controlled Trial
. 2022 Aug;208(2):292-300.
doi: 10.1097/JU.0000000000002696. Epub 2022 Apr 15.

Results from 22 years of Followup in the Göteborg Randomized Population-Based Prostate Cancer Screening Trial

Maria Frånlund  1 , Marianne Månsson  1 , Rebecka Arnsrud Godtman  1 , Gunnar Aus  2 , Erik Holmberg  3 , Karin Stinesen Kollberg  1 , Pär Lodding  1 , Carl-Gustaf Pihl  4 , Johan Stranne  1 , Hans Lilja  5   6   7   8   9 , Jonas Hugosson  1
Affiliations
Randomized Controlled Trial

Results from 22 years of Followup in the Göteborg Randomized Population-Based Prostate Cancer Screening Trial

Maria Frånlund et al. J Urol. 2022 Aug.

Abstract

Purpose: Our goal was to analyze results from 22 years of followup in the Göteborg randomized prostate cancer (PC) screening trial.

Materials and methods: In December 1994, 20,000 men born 1930-1944 were randomly extracted from the Swedish population register and were randomized (1:1) into either a screening group (SG) or to a control group (CG). Men in the SG were repeatedly invited for biennial prostate specific antigen testing up to an average age of 69 years. Main endpoints were PC incidence and mortality (intention-to-screen principle).

Results: After 22 years, 1,528 men in the SG and 1,124 men in the CG had been diagnosed with PC. In total, 112 PC deaths occurred in the SG and 158 in the CG. Compared with the CG, the SG showed a PC incidence rate ratio (RR) of 1.42 (95% CI, 1.31-1.53) and a PC mortality RR of 0.71 (95% CI, 0.55-0.91). The 22-year cumulative PC mortality rate was 1.55% (95% CI, 1.29-1.86) in the SG and 2.13% (95% CI, 1.83-2.49) in the CG. Correction for nonattendance (Cuzick method) yielded a RR of PC mortality of 0.59 (95% CI, 0.43-0.80). Number needed to invite and number needed to diagnose was estimated to 221 and 9, respectively. PC death risk was increased in the following groups: nontesting men, men entering the program after age 60 and men with >10 years of followup after screening termination.

Conclusions: Prostate specific antigen-based screening substantially decreases PC mortality. However, not attending, starting after age 60 and stopping at age 70 seem to be major pitfalls regarding PC death risk.

Keywords: epidemiology; mass screening; mortality; prostate-specific antigen; prostatic neoplasms.

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Conflict of interest statement

Conflict of Interest: Hans Lilja holds patents for intact PSA assays, and is named on a patent application for a statistical method to detect prostate cancer. These patents have been licensed and commercialized as the 4Kscore® by OPKO Health. Dr. Lilja receives royalties from sales of this test and owns stock in OPKO.

Figures

Figure 1.
Figure 1.
Flow chart, 22 years of screening. FU, followup.
Figure 2.
Figure 2.
A, observed PC incidence up to December 31, 2016 (19,894). B, observed PC mortality up to December 31, 2016 (19,894).
See this image and copyright information in PMC

Comment in

References

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