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US trial shows no early mortality benefit from annual prostate cancer screening
Date:3/18/2009

re has been no demonstration that screening will prolong their lives."

Of the men who received annual screening, 85 percent had PSA tests and 86 percent had digital rectal exams. Men in the routine-care arm sometimes had prostate cancer screening tests: PSA screening ranged from 40 percent of men at the beginning of the study to 52 percent of men by the last screening year, and screening with rectal exams ranged from 41 percent initially to 46 percent by the last screening year. The exam involves a doctor inserting a lubricated, gloved finger into the rectum to feel for anything that is not normal.

Men were referred for follow up testing for prostate cancer if their PSA level was higher than 4.0 ng/ml or if the rectal exam was abnormal.

The researchers noted that the vast majority of men in both groups who developed prostate cancer were diagnosed with stage II disease (out of IV). The number of later-stage cases was similar in the two groups. However, men in the routine-care group had more aggressive tumors (Gleason score 8-10). The reduced number of men with prostate cancer with a Gleason score of 8-10 in the intervention group may eventually lead to a mortality difference, but data analyzed so far have not shown such a benefit.

Additionally, men in both groups received similar treatments for their disease, which was not dictated by being a participant in the PLCO.

Another study reported in this same online issue of the NEJM is the large European Randomized Trial of Screening for Prostate Cancer (ERSPC), which shows a 20 percent reduction in the rate of death from prostate cancer but with a high risk of overdiagnosis. In the ERSPC, unlike the PLCO trial, men were referred for follow-up testing if their PSA level was 3.0 ng/mL or higher and were also screened, on average, every four years as opposed to annually in the PLCO.

Lowering the threshold for what is considered an abnormal PSA to 3.0 ng/ml is likely to d
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Contact: Caroline Arbanas
arbanasc@wustl.edu
314-286-0109
Washington University School of Medicine
Source:Eurekalert

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