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Four-year prostate cancer screening interval is effective

J Fam Pract. 2004 February;53(2):93-105
By
Kenneth G. Schellhase, MD, MPH
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  • BACKGROUND: Screening for prostate cancer is still controversial as it has not been shown to decrease mortality. A large randomized screening trial designed to determine screening efficacy is ongoing. Despite uncertain benefit, many men choose to be screened in routine clinical practice. The appropriate interval for prostate cancer screening has not been determined.
  • POPULATION STUDIED: This study was part of the European Randomized Study of Screening for Prostate Cancer (ERSPC). This analysis used the study arm based in Rotterdam, Denmark, where the researchers enrolled 17,226 men aged 55 to 74 years. There were 8350 men in the screening arm, and 8876 men in the control (unscreened) arm. Other than age, demographics of the study population were not reported.
  • STUDY DESIGN AND VALIDITY: This was a multicenter randomized screening trial. Men in the intervention arm of the study were offered a battery of 3 screening tests for prostate cancer: blood prostate-specific antigen (PSA) level testing, digital rectal exam, and transrectal prostate ultrasound. Initial screenings occurred between October 1993 and December 1996. Repeat screening occurred 4 years later, finishing by December 2000.
  • OUTCOMES MEASURED: Diagnosis of prostate cancer during the 4-year intervals between screenings.
  • RESULTS: There were 152 prostate cancers diagnosed among the 8876 control subjects (1.7%), of which 135 were diagnosed within 4 years of randomization. Twenty-five prostate cancers were diagnosed among the 8350 intervention subjects outside of the screening trial—ie, during the 4-year interval between screenings. Twenty-two of these 25 cancers were early stage, and none were metastatic. The sensitivity of the screening regimen in this study was 79.8%.
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PRACTICE RECOMMENDATIONS

This study found a relatively low rate of prostate cancer diagnoses during a 4-year interval between screenings in Danish men aged 55 to 74 years. For those men choosing to undergo prostate cancer screening, these results show that annual screening is not necessary. Whether screening reduces prostate cancer-specific mortality is yet to be determined.

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