Prostate cancer in the Swedish section of ERSPC--evidence for less metastases at diagnosis but not for mortality reduction.

摘要

In this issue of the journal, Aus et al. report on the risk of being diagnosed with advanced (metastatic) prostate cancer among men in the Swedish randomised screening study, which is part of the European Randomized Study of Screening for Prostate Cancer (ERSPG) . In brief, 20,000 men aged 50-66 yr were randomly selected from the Goteborg population registry and randomised to screening and control groups. Men with pre-existing prostate cancer were excluded. A prostate-specific antigen (PSA) level >=3.0 ng/ml standardised to the Beckman Hybritech Access~R was the only indication for biopsy. The screening interval was 2 yr; the group reports on the prevalence screen and four subsequent rounds of screening covering a total of 10 yr. Metastatic disease at the time of diagnosis is reported and includes the metastatic cancers, which surfaced during the screening intervals (interval cancers) but not cancers that were diagnosed during follow-up after the 10-yr period. Throughout the paper the authors clearly express that the purpose of the their report was to study the effectiveness of the screening programme in terms of reducing metastatic disease at the time of diagnosis. In the intention-to-screen analysis, which includes 2456 men in the screening arm (25%) who were non-compliant by not responding to the invitation to screening, 47 advanced cases were found in the control group and 24 in the screening group, a difference of 49%. In total, 810 prostate cancers were diagnosed in the screening arm and 442 in the control arm.