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N Engl J Med. 2009 Mar 26;360(13):1320-8. doi: 10.1056/NEJMoa0810084. Epub 2009 Mar 18.

Screening and prostate-cancer mortality in a randomized European study.

Collaborators (156)

Smith P, Adolfsson J, Hakulinen T, Chamberlain J, Collette B, Alexander F, de Beaufort I, Kirkels WJ, Rietbergen JB, van der Cruijsen IW, Raaijmakers R, de Vries SH, Roemeling S, Gosselaar C, Wolters T, van den Bergh RC, van Leeuwen PJ, Yurdakul G, Boeken-Kruger A, Wijburg C, Forouzanfor M, De Boer M, Postma R, Vis AN, Hoedemaeker R, Van Leenders A, van Schaik R, van der Maas PJ, Otto S, Draisma G, Beemsterboer P, Essink-Bot M, Korfage I, Boer R, Wildhagen M, Heijnsdijk E, Merkelbach W, Hoekstra W, Blom J, Damhuis RA, Reedijk A, Kranse R, Roobol DW, Roobol W, van den Berg E, de Zwart GJ, Franken-Raab CG, van Slooten-Midderig M, Smit A, van der Drift V, de Bilde E, Mani L, Visser-van Dongen M, Versteeg-Leenheer H, Zoutendijk B, Vink N, van Meurs H, de Bruijn AE, Devriendt H, Thijs G, Hermans A, D'Hooge K, Neels H, Wauters A, Neetens I, Kockx M, Keuppens F, Braeckman J, Govaerts F, Spinnewijn B, Van Hoey M, Putzeys T, De Coninck M, Dourcy-Belle-Rose B, Vancauwenbergh A, Coebergh JW, Verhaegen H, Van Vliet, Standaert B, Nyberg M, Bergdahl S, Lodding P, Khatami A, Stranne J, Ahlgren H, Eriksson GB, Becker C, Carlsson S, Grenabo A, Pettersson S, Varenhorst E, Norlén BJ, Zackrisson B, Holmberg E, Frösing R, Pileblad E, Pihl CG, Kujala P, Laurila M, Stenman UH, Finne P, Ruutu M, Ala-Opas M, Aro J, Juusela H, Mildh M, Hakama M, Lahtela J, Karhunen PJ, Mäkinen T, Visakorpi T, Isola J, Cappellini M, Bianchi S, Lombardi C, Bussotti A, Bastiani P, Bonardi R, Mazzotta A, Bartoli D, Bonfrisco L, Crocetti E, Martinelli F, Zendron P, Frullini P, Di Lollo S, Rubeca T, Páez A, Pascual C, Santonja C, Huber A, Tscholl R, Stamm B, Wernli M, Kurrer M, Bodis S, Lautenschlager T, Bubendorf L, Lehmann K, Bugliani G, Steurer J, Hemming J, Coulson P, Coleman D, Van der Kwast T, van Leenders GJ, Hoedemaeker RF, Pihl CG, Martikainen PM, Laurila M, Bubendorf L, Santonja C, Neetens I, DiLollo S, Mazerolles C, Lopes C.

Author information

  • 1Department of Urology , Erasmus Medical Center, Rotterdam, The Netherlands.



The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific-antigen (PSA) testing on death rates from prostate cancer.


We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006.


In the screening group, 82% of men accepted at least one offer of screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P=0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The analysis of men who were actually screened during the first round (excluding subjects with noncompliance) provided a rate ratio for death from prostate cancer of 0.73 (95% CI, 0.56 to 0.90).


PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. (Current Controlled Trials number, ISRCTN49127736.)

2009 Massachusetts Medical Society

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