Swedish study showed almost 50% reduction in prostate-cancer death with PSA screening program

Fourteen-year follow-up data from the Göteburg randomized population-based prostate-cancer screening trial indicated that men who were screened for cancer using PSA testing every 2 years had almost half the prostate-cancer mortality as men who were not screened.

In an accompanying editorial, David E. Neal, FMedSci, MS, FRCS, at the University of Cambridge, U.K., was cautiously optimistic about the results. Neal said that the findings “show that in certain circumstances, PSA testing and early diagnosis reduces death from prostate cancer.” However, he added, “it does not imply that PSA screening programs should now be introduced internationally.”

Researchers randomly sampled 20,000 men born in Göteburg, Sweden, between 1930 and 1944. In December 1994, they were randomly assigned to either a screening group invited for PSA testing every 2 years or a control group. If men were found to have an elevated PSA, they were offered additional tests. The primary endpoint was prostate-cancer specific mortality.

Of the men in the screening group, 76% attended at least one screening; 33% of these men had an elevated PSA at least once.

After 14 years follow-up, 11.4% of the men in the screening group were diagnosed with prostate cancer vs. 7.2% in the control group. The researchers reported that of those men in the screening group with prostate cancer, the diagnosis was the result of a study screening in 78.7%. The cumulative incidence of prostate cancer was 12.7% in the screening group vs. 8.2% in the control group (HR=1.64; 95% CI, 1.50-1.80).

Men assigned to the screening group had a 0.40% absolute cumulative-risk reduction of prostate-cancer specific mortality at 14 years compared with men in the control group (from 0.90% in the control group to 0.50% in the screening group).

“These outcomes compare favorably with well-established screening programs for breast and colorectal cancer and add further evidence to the outcomes of the European Randomized Study of Screening for Prostate Cancer (ERSPC),” Neal wrote.

Hugosson J. Lancet Oncol. 2010;doi:10.1016/S1470-2045(10)70146-7.