@Article{,
AUTHOR = {Fritz H. Schröder},
TITLE = {Detection of prostate cancer: the impact of the European Randomized Study of Screening for Prostate Cancer (ERSPC)},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {12},
YEAR = {2005},
NUMBER = {Suppl.1},
PAGES = {2--6},
URL = {http://www.techscience.com/CJU/v12nSuppl.1/63373},
ISSN = {1488-5581},
ABSTRACT = {The European Randomized Study of Screening for
Prostate Cancer (ERSPC) is a large, randomized
controlled trial of screening versus control, conducted in
eight European countries (Belgium, Finland, France,
Italy, the Netherlands, Spain, Sweden, and Switzerland).
This article focuses on important aspects relating to recent
findings from the ERSPC about two topics: first, leadtime
and overdiagnosis, and second, prostate-specific antigen
(PSA) as a test for repeated screening.<br/>
The ERSPC together with the prostate cancer arm of the
Prostate, Lung, Colon and Ovary (PLCO) screening trial
of the National Cancer Institute in the United States are
set to show or exclude an effect of screening on prostate
cancer mortality. Both studies are progressing according
to plan. Definitive endpoint-related data can be expected
between 2005 and 2010 depending on the difference in
prostate cancer mortality that may be shown between the
screening and control arms. The ERSPC will allow a riskto-benefit analysis including parameters of quality of life
and cost.<br/>
Overdiagnosis with present prostate cancer screening
regimens is high. This amount of overdiagnosis is likely
to be unacceptable for most healthcare policy makers and
providers. Addressing overdiagnosis will be a major
research task for urologists for the years to come. Present
screening needs to be more “selective” for cases that have
aggressive patterns and are likely to lead to clinical
diagnosis of prostate cancer and/or death. The test
characteristics of prostate-specific antigen (PSA) change
after one use. The positive relation between PSA levels
and positive predictive value (PPV) and detection rates
in first screening rounds are lost. This may be compatible
with the observation that tumor volumes in second round
screening are smaller, and larger tumors are harvested.
Tumor volume becomes a negative predictor in round 2,
indicating that a large proportion of elevated PSA values
are caused by benign prostatic hyperplasia (BPH) rather
than by prostate cancer. While the outcome of the ongoing
randomized studies is uncertain, screening tests cannot
be refused to men who are well-informed and accept to
take the risk of experiencing more harm than benefit as a
result of a positive screening test result.},
DOI = {}
}