PSA screening for prostate cancer is associated with a 20% reduction in mortality from the disease, according to findings from the largest prostate cancer study ever conducted.

The European Randomized Study of Screening for Prostate Cancer (ERSPC) started in the early 1990s and involved eight countries: Belgium, Finland, France, Italy, the Netherlands, Spain, Sweden, and Switzerland. The study enrolled 162,000 men aged 55-69 years (the core age group) who had not been previously screened.

The study also enrolled men aged 50-54 and 70-74 years, bringing the total to 182,000 participants, although not all centers contributed patients.

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PSA screening led to an increase in early detection, decreasing the number of deaths due to metastasized disease, researchers reported at the 24th Annual European Association of Urology Congress in Stockholm. Findings also have been published online in the New England Journal of Medicine (NEJM).  

Men with a PSA level of 3.0 ng/mL or higher were offered a prostate biopsy. Screening took place on average every four years, with a mean follow-up of more than nine years.

On average, 1,408 men needed to be screened and 48 needed to be treated to save one prostate cancer death, according to researchers.

The study’s finding of a 20% reduction in prostate cancer mortality with screening “provides decision makers on screening policies with important new data on the effectiveness of PSA testing in preventing deaths,” said Fritz H. Schröder, MD, PhD, of Erasmus Medical Center in the Netherlands and international coordinator of the ERSPC study.

“However, the ERSPC is also near to completing additional studies on quality of life and cost-effectiveness and these must be assessed before making a decision about the appropriateness of a national prostate screening policy.”

NEJM simultaneously published the results of a large American study—the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial—showing that prostate cancer screening made no difference in prostate cancer death rates at seven and 10 years of follow up.

Researchers randomly assigned more than 76,600 men to receive usual care or to have annual PSA tests for six years and digital rectal examinations annually for four years.