Eighteen-year follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial: effect of sociodemographic variables on participation, prostate cancer incidence and mortality

Abstract

Objective: This study examined whether previously reported results, indicating that prostate-specific antigen (PSA) screening can reduce prostate cancer (PC) mortality regardless of sociodemographic inequality, could be corroborated in an 18 year follow-up.

Materials and methods: In 1994, 20,000 men aged 50–64 years were randomized from the Göteborg population register to PSA screening or control (1:1) (study ID: ISRCTN54449243). Men in the screening group (n = 9950) were invited for biennial PSA testing up to the median age of 69 years. Prostate biopsy was recommended for men with PSA ≥2.5 ng/ml. Last follow-up was on 31 December 2012.

Results: In the screening group, 77% (7647/9950) attended at least once. After 18 years, 1396 men in the screening group and 962 controls had been diagnosed with PC [hazard ratio 1.51, 95% confidence interval (CI) 1.39–1.64]. Cumulative PC mortality was 0.98% (95% CI 0.78–1.22%) in the screening group versus 1.50% (95% CI 1.26–1.79%) in controls, an absolute reduction of 0.52% (95% CI 0.17–0.87%). The rate ratio (RR) for PC death was 0.65 (95% CI 0.49–0.87). To prevent one death from PC, the number needed to invite was 231 and the number needed to diagnose was 10. Systematic PSA screening demonstrated greater benefit in PC mortality for men who started screening at age 55–59 years (RR 0.47, 95% CI 0.29–0.78) and men with low education (RR 0.49, 95% CI 0.31–0.78).

Conclusions: These data corroborate previous findings that systematic PSA screening reduces PC mortality and suggest that systematic screening may reduce sociodemographic inequality in PC mortality.

Keywords:

• Mass screening
• prostate cancer
• prostate-specific antigen
• socioeconomic factors

Acknowledgements

We thank the cause of death committee (Bo Johan Norlén, Silas Petterson, Eberhard Varenhorst and Per Folmerz), database manager Helén Ahlgren and study nurse Maria Nyberg. We also thank Amy Plofker at MSKCC for polishing the manuscript.

Disclosure statement

HL holds patents for free PSA, human kallikrein-related peptidase 2 and intact PSA assays. HL is named on a patent for a statistical method to detect PC that is commercialized by OPKO Health.HL owns stock in OPKO and receives royalties from any sales of the test. HL has served on an advisory panel for Roche Diagnostics during 2014, and an immediate family member of HL is an employee at Ferring Pharmaceuticals. There are no other relationships or activities that have influenced the submitted work. The funders of the study had no role in the design of the study, the collection, analysis and interpretation of data, the writing of the report or the decision to submit the article for publication. The researchers of this study are independent from the funders.

Additional information

Funding

This work was supported by the Swedish Cancer Society [contract numbers 14 0694, 11 0178 and 14 0722], Swedish Research Council (VR-MH 2016-02974), Sahlgrenska University Hospital, SC is funded by a postdoctoral research grant from AFA insurance, HL is supported in part by Oxford Biomedical Research Centre Program in UK, and the work of SC and HL is supported in part by a Cancer Center Support Grant from the National Institutes of Health/National Cancer Institute (NIH/NCI) made to Memorial Sloan Kettering Cancer Center [P30 CA008748], the MSKCC SPORE in Prostate Cancer (P50CA092629), and the Sidney Kimmel Center for Prostate and Urologic Cancers, David H. Koch through the Prostate Cancer Foundation.