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Eur Urol. 2014 Sep;66(3):401-3. doi: 10.1016/j.eururo.2013.12.055. Epub 2014 Jan 7.

A different method of evaluation of the ERSPC trial confirms that prostate-specific antigen testing has a significant impact on prostate cancer mortality.

Author information

1
Clinical and Descriptive Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy. Electronic address: m.zappa@ispo.toscana.it.
2
Clinical and Descriptive Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy.
3
Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
4
Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
5
Department of Urology, Erasmus MC, Rotterdam, The Netherlands; Comprehensive Cancer Centre The Netherlands, Utrecht, The Netherlands.
6
School of Health Sciences, University of Tampere, Tampere, Finland.
7
Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
8
Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
9
Provinciaal Instituut voor Hygiëne, Antwerp, Belgium.
10
Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
11
Department of Urology, CHU Lille, University Lille Nord de France, Lille, France.

Abstract

The advantages and disadvantages of two different methods of analyzing the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial with respect to the effect of prostate-specific antigen (PSA) screening on prostate cancer (PCa) mortality (ie, disease-specific mortality analysis and excess mortality analysis) are discussed in depth. The traditional disease-specific mortality is the best end point, but it could be biased by misclassification of causes of death, and it does not take into account the possible effect of the screening process on other causes of death. Excess mortality analysis overcomes these problems, but the results could be biased if the expected mortality is not corrected for attendance status. Both methods, when applied to the ERSPC trials, demonstrate that no increase in non-PCa mortality occurred in the screening group and confirm that PSA screening decreases PCa mortality.

KEYWORDS:

Excess mortality; Screening

PMID:
24412230
DOI:
10.1016/j.eururo.2013.12.055
[Indexed for MEDLINE]
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