Mortality Results from a Randomized Prostate-Cancer Screening Trial

By G. Andriole, E. Crawford, R. Grubb, S. Buys, D. Chia, T. Church, M. Fouad, E. Gelmann, P. Kvale, D. Reding and 14 more. New England Journal of Medicine, 2009

2,929 citations recorded by the source corpus.

BACKGROUND The effect of screening with prostate-specific–antigen (PSA) testing and digital rectal examination on the rate of death from prostate cancer is unknown. This is the first report from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial on prostate-cancer mortality. METHODS From 1993 through 2001, we randomly assigned 76,693 men at 10 U.S. study centers to receive either annual screening (38,343 subjects) or usual care as the control (38,350 subjects). Men in the screening group were offered annual PSA testing for 6 years and digital rectal examination for 4 years. The subjects and health care providers received the results and decided on the type of follow-up evaluation. Usual care sometimes included screening, as some organizations have recommended. The numbers of all cancers and deaths and causes of death were ascertained. RESULTS In the screening group, rates of compliance were 85% for PSA testing and 86% for digital rectal examination. Rates of screening in the control group increased from 40% in the first year to 52% in the sixth year for PSA testing and ranged from 41 to 46% for digital rectal examination. After 7 years of follow-up, the incidence of prostate cancer per 10,000 person-years was 116 (2820 cancers) in the screening group and 95 (2322 cancers) in the control group (rate ratio, 1.22; 95% confidence interval [CI], 1.16 to 1.29). The incidence of death per 10,000 person-years was 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group (rate ratio, 1.13;95% CI,0.75 to 1.70). The data at 10 years were 67% complete and consistent with these overall findings. CONCLUSIONS After 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups.

Subfields: Oncology, Public Health, Environmental and Occupational Health, Pulmonary and Respiratory Medicine

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Citations in the corpus

Annual Report to the Nation on the Status of Cancer, 1975–2006, Featuring Colorectal Trends and Impact of Interventions (Risk Factors, Screening, and Treatment) to Reduce Future Rates (2010, methodology): “The few randomized trials on prostate cancer screening produced conflicting results with various methodologies.(56,57) Consequently, comparative microsimulation modeling is being used to better understand the progression of the disease, the impact of screening on mortality, and cost implications of ”
Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities (2016, background): “Results from a US-based randomized trial indicated no reduction in prostate cancer mortality as a result of PSA testing, while two European trials showed a modest benefit.(102-104) Studies also suggest that black men are less likely to receive surgical treatment than white men with similar disease c”
Epidemiology of Prostate Cancer (2019, background): “However, in the USA, a recent randomized controlled trial failed to demonstrate benefits of PSA testing in decreasing prostate cancer deaths, although another research study done in Europe showed benefits of PSA testing [29, 30].”
Computer Aided-Diagnosis of Prostate Cancer on Multiparametric MRI: A Technical Review of Current Research (2014, result): “However, other large studies found conflicting results, reporting that PSA screening had no significant effect on PCa death rate [7, 8].”
“A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer” (2019, neutral): “No PCa mortality reduction was shown after 15 yr in the US PLCO trial, which applied only 6 yr of screening [22].”
Computer-Aided Detection and diagnosis for prostate cancer based on mono and multi-parametric MRI: A review (2015, background): “Although PSA screening has been shown to improve early detection of CaP [36], its lack of reliability motivates further investigations using MRI [37–39].”
An introduction to implementation science for the non-specialist (2015, background): “However, it is clear from many studies that the assumption that improved processes mean improved health outcomes is flawed [59, 60].”
International variation in prostate cancer incidence and mortality rates. (2012, neutral): “In addition, recent results from a randomized PCa screening trial in the United States failed to show a benefit from screening related to PCa mortality, whereas a trial in Europe found a PCa mortality reduction of 20% attributable to screening [55] [56].”