Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct 3;167(7):449-455.
doi: 10.7326/M16-2586. Epub 2017 Sep 5.

Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials

Alex Tsodikov  1 , Roman Gulati  1 , Eveline A M Heijnsdijk  1 , Paul F Pinsky  1 , Sue M Moss  1 , Sheng Qiu  1 , Tiago M de Carvalho  1 , Jonas Hugosson  1 , Christine D Berg  1 , Anssi Auvinen  1 , Gerald L Andriole  1 , Monique J Roobol  1 , E David Crawford  1 , Vera Nelen  1 , Maciej Kwiatkowski  1 , Marco Zappa  1 , Marcos Luján  1 , Arnauld Villers  1 , Eric J Feuer  1 , Harry J de Koning  1 , Angela B Mariotto  1 , Ruth Etzioni  1
Affiliations

Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials

Alex Tsodikov et al. Ann Intern Med. .

Abstract

Background: The ERSPC (European Randomized Study of Screening for Prostate Cancer) found that screening reduced prostate cancer mortality, but the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial) found no reduction.

Objective: To evaluate whether effects of screening on prostate cancer mortality relative to no screening differed between the ERSPC and PLCO.

Design: Cox regression of prostate cancer death in each trial group, adjusted for age and trial. Extended analyses accounted for increased incidence due to screening and diagnostic work-up in each group via mean lead times (MLTs), which were estimated empirically and using analytic or microsimulation models.

Setting: Randomized controlled trials in Europe and the United States.

Participants: Men aged 55 to 69 (ERSPC) or 55 to 74 (PLCO) years at randomization.

Intervention: Prostate cancer screening.

Measurements: Prostate cancer incidence and survival from randomization; prostate cancer incidence in the United States before screening began.

Results: Estimated MLTs were similar in the ERSPC and PLCO intervention groups but were longer in the PLCO control group than the ERSPC control group. Extended analyses found no evidence that effects of screening differed between trials (P = 0.37 to 0.47 [range across MLT estimation approaches]) but strong evidence that benefit increased with MLT (P = 0.0027 to 0.0032). Screening was estimated to confer a 7% to 9% reduction in the risk for prostate cancer death per year of MLT. This translated into estimates of 25% to 31% and 27% to 32% lower risk for prostate cancer death with screening as performed in the ERSPC and PLCO intervention groups, respectively, compared with no screening.

Limitation: The MLT is a simple metric of screening and diagnostic work-up.

Conclusion: After differences in implementation and settings are accounted for, the ERSPC and PLCO provide compatible evidence that screening reduces prostate cancer mortality.

Primary funding source: National Cancer Institute.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Estimated mean lead times (years) in the intervention and control arms of the ERSPC and PLCO relative to a hypothetical no-screening setting (where lead time is always zero)
Estimated MLTs are visualized as increasing to the left to suggest the extent to which prostate cancer diagnosis is advanced by more intensive screening and diagnostic workup. ERSPC=European Randomized Study of Screening for Prostate Cancer; PLCO=Prostate, Lung, Colorectal, and Ovarian cancer screening trial; FHCRC=Fred Hutchinson Cancer Research Center; MISCAN=Erasmus University Medical Center MIcrosimulation SCreening ANalysis; UMICH=University of Michigan
Figure 2
Figure 2. Prostate cancer survival from randomization in the ERSPC and PLCO estimated by Kaplan-Meier or Cox regression model using mean lead time estimated using the empirical approach
ERSPC=European Randomized Study of Screening for Prostate Cancer; PLCO=Prostate, Lung, Colorectal, and Ovarian cancer screening trial
See this image and copyright information in PMC

Comment in

Summary for patients in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Moyer VA Force USPST. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(2):120–34. - PubMed
    1. Jemal A, Fedewa SA, Ma J, Siegel R, Lin CC, Brawley O, et al. Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations. JAMA. 2015;314(19):2054–61. - PubMed
    1. Jemal A, Ma J, Siegel R, Fedewa S, Brawley O, Ward EM. Prostate Cancer Incidence Rates 2 Years After the US Preventive Services Task Force Recommendations Against Screening. JAMA Oncol. 2016;2(12):1657–60. - PubMed
    1. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine. 2009;360(13):1320–8. - PubMed
    1. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Prostate-cancer mortality at 11 years of follow-up. New England Journal of Medicine. 2012;366(11):981–90. - PMC - PubMed