Results of Prostate Cancer Screening in a Unique Cohort at 19 yr of Follow-up

We assessed the effect of screening in the European Randomized study of Screening for Prostate Cancer (ERSPC) Rotterdam pilot 1 study cohort with men randomized in 1991–1992. A total of 1134 men were randomized on a 1:1 basis to a screening (S) and control (C) arm after prostate-specific antigen (PSA) testing (PSA ≥10.0 ng/ml was excluded from randomization). Further PSA testing was offered to all men in the S-arm with 4-yr intervals starting at age 55 yr and screened up to the age of 74 yr. Overall, a PSA level of ≥3.0 ng/ml triggered biopsy. At time of analysis, 63% of men had died. Overall relative risk of metastatic (M+) disease and prostate cancer (PCa) death was 0.46 (95% confidence interval [CI]: 0.19–1.11) and 0.48 (95% CI: 0.17–1.36), respectively, in favor of screening. This ERSPC Rotterdam pilot 1 study cohort, screened in a period without noteworthy contamination, shows that PSA-based screening could result in considerable reductions of M+ disease and mortality which if confirmed in larger datasets should trigger further discussion on pros/cons of PCa screening. Patient summary: In a cohort with 19 yr of follow-up, we found indications for a more substantial reduction in metastatic disease and cancer-specific mortality in favor of prostate cancer screening than previously reported. If confirmed in larger cohorts, these findings should be considered in the ongoing discussion on harms and benefits of prostate cancer screening. The considerable reduction in both metastatic disease and prostate cancer (PCa) mortality in a cohort with 19 yr of follow-up, largely without prostate-specific antigen (PSA) contamination and >60% of men deceased, suggests a stronger benefit of PSA-based PCa screening than so far reported. Confirmation of these results could lead to new insights on the harm-benefit ratio of PCa screening.

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