Screening for prostate cancer (PC)-an update on re...[Urol Oncol. 2008 Sep-Oct] - PubMed Result

September 17, 2008

Urol Oncol. 2008 Sep-Oct;26(5):533-41. Links

Screening for prostate cancer (PC)-an update on recent findings of the

European Randomized Study of Screening for Prostate Cancer (ERSPC).

Schröder FH.

Department of Urology, Erasmus MC, Rotterdam, The Netherlands.

Introduction for screening for prostate cancer as a healthcare policy is

desirable provided its effectiveness can be shown in terms of decreasing

prostate cancer mortality at an acceptable price in terms of quality of life

and costs. The European Randomized Study of Screening for Prostate Cancer

(ERSPC) was initiated in 1993 and should in 2008 have the power to produce

the required information. The structure and status of ERSPC. ERSPC is a

randomized controlled trial running in eight European countries (Belgium,

Finland, France, Italy, The Netherlands, Spain, Sweden, and Switzerland). A

total of 267,994 have been randomized to screening vs. control. An interim

look at the data has taken place in 2006; the advice of the Data Monitoring

Committee was to continue the study. This was based on a total of 23,794

deaths in both study groups, 6,033 cases of prostate cancer detected in both

groups of which about 1, 200 had died. Contributions to a better

understanding of the screening methodology. ERSPC has contributed with a

large number of publications, either coming from individual centers or

combining data of several centers. A complete listing can be found at

www.erspc.org. Lead-time and overdiagnosis with the screening regimen

utilized in ERSPC Rotterdam were established to amount to 10.3 years and

54%. This information is of great importance for the development of further

screening strategies. During the process of ERSPC, digital rectal

examination was omitted and replaced by the inclusion of PSA 3-4 as a biopsy

indication. The data on which this decision has been based were published

and validated. Overdiagnosis and overtreatment have an adverse influence on

quality of life, as it will be included in the evaluation of ERSPC. The

recent development of a nomogram for the identification of indolent disease

is a major step to improve on this outcome parameter. The application of

this nomogram to screen detected cases allows the the advice " active

observation " to about 30% of such patients. ERSPC is set to show or exclude

at least a 25% reduction in prostate cancer mortality through screening.

Many pending problems still have to be resolved prior to the introduction of

populations based screening as a worldwide healthcare policy.

PMID: 18774469 [PubMed - in process

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