Prostate-Specific Antigen Screening and Prostate Cancer Mortality: Implications of a Randomized European Study

Evaluation of: Schroder FH, Hugosson J, Roobol MJ et al.: Screening and prostate-cancer mortality in a randomized European study. N. Engl. J. Med. 360, 1320–1328 (2009). Over the past two decades, prostate-specific antigen has become the primary modality for prostate cancer screening and has led to earlier detection. However, the question remains as to whether earlier detection actually leads to reductions in prostate cancer-specific mortality, especially since prostate cancer treatment can be associated with significant quality-of-life issues, including impotence and incontinence. Recently, long-term studies from Europe and the USA have demonstrated conflicting results with regard to this question. The European study demonstrated a 20% reduction in prostate cancer-specific mortality in men receiving routine screening, but concluded that 1410 men would need screening and 48 men would need treatment for prostate cancer in order to prevent one death. These findings demonstrated that prostate-specific antigen screening reduces prostate cancer-specific mortality, but reconfirmed the association of screening with a significant rate of overdiagnosis.