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European Randomized Study of Screening for Prostate Cancer (ERSPC)
The ERSPC involved 182,160 men 50 to 74 years of age at study entry from 8 European countries. There was a predefined core age group of 162,388 men 55 to 69 years of age.
Participants were randomized to either PSA screening or no screening, and the primary outcome was mortality from prostate cancer.
The median screening interval was 4 years. In the screening group, 6963 prostate cancers were diagnosed (cumulative incidence, 9.6%), as were 5396 in the control group (cumulative incidence, 6.0%). There were approximately 1000 more cases of prostate cancer in each study group than in the previous analysis.
There were 299 deaths from prostate cancer in the screening group and 462 in the control group (mortality rate, 0.39 vs 0.50 per 1000 person-years). The rate ratio was 0.79 (95% confidence interval [CI], 0.68 to 0.91; P = .001), which corresponded to a relative risk reduction of 21%, in favor of PSA screening.
In addition, there was an absolute difference in mortality of 0.10 deaths per 1000 person-years, or 1.07 deaths per 1000 men randomized. After correction for selection bias and noncompliance, the authors found an adjusted rate ratio of 0.71 (95% CI, 0.58 to 0.86; P = .001) for screened men, corresponding to a 29% relative risk reduction.
The rate ratios for years 1 to 9 was 0.85 (95% CI, 0.71 to 1.03) and for years 1 to 11 was 0.79 (95% CI, 0.67 to 0.92).
Screening did not lead to a decrease in overall mortality, which was similar in the screened and control groups (18.2 vs 18.5 per 1000 person-years; rate ratio, 0.99; 95% CI, 0.97 to 1.01).
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