Smarter screening for prostate cancer: for the few, not the many? A stratified approach based on baseline risk

Abstract

Evaluation of: van Leeuwen PJ, Connolly D, Tammela TLJ et al. Balancing the harms and benefits of early detection of prostate cancer. Cancer 116(20), 4857–4865 (2010).

Prostate cancer screening remains controversial, with different countries taking different views on its value. We review the study by van Leeuwen and colleagues, evaluating the risk–benefit ratio for screening from the European Randomized study of Screening for Prostate Cancer (ERSPC) stratified by age and serum prostate-specific antigen level at study entry. Though the overall results from the ERSPC demonstrated a 20% relative reduction in prostate cancer mortality in the screened arm, the current study demonstrated that the benefit was minimal for men aged 55–74 years with a serum prostate-specific antigen <4 ng/ml and came at the expense of significant overdiagnosis and overtreatment. This study adds to the growing body of evidence that prostate cancer screening works, but not for everyone, and suggests a smarter strategy of targeted screening to those most at risk from prostate cancer mortality.

Keywords::

• early detection
• ERSPC
• prostate cancer
• screening

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.