Source: Schroder FH, et al. Screening and prostate cancer mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet2014;384:2027-2035
The pendulomic swing in enthusiasm for prostate cancer screening from strong endorsement to disenchantment resulted from a huge clinical trial database that included two mega trials that enrolled more than 250,000 men. One trial, the European Randomised Study of Screening for Prostate Cancer ([ERSPC] n = 182,160), demonstrated a reduction in prostate cancer-related mortality at 9-years follow-up, but no reduction in total mortality. Since all-cause mortality was not reduced, policymakers rightly questioned the propriety of advising large-scale screening if the overall rate of death was not altered.
The ERSPC now has data on up to 13 years of follow-up that remain concordant with their findings at 9 and 11 years: a reduction in prostate cancer mortality (rate ratio 0.79 or a 21% reduction), but again, no reduction in all-cause mortality.
Although a 21% relative reduction in prostate cancer mortality might seem impressive, the absolute risk reduction is much less so: avoidance of one prostate cancer death per 781 men screened. Based on the recommendations of the United States Preventive Services Task Force, most primary care clinicians have minimized screening of average-risk adult men for prostate cancer. These results confirm the rationale for that clinical posture.