Screening for prostate cancer (PC)--an update on recent findings of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

Introduction for screening for prostate cancer as a healthcare policy is desirable provided its effectiveness can be shown in terms of decreasing prostate cancer mortality at an acceptable price in terms of quality of life and costs. The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in 1993 and should in 2008 have the power to produce the required information. The structure and status of ERSPC. ERSPC is a randomized controlled trial running in eight European countries (Belgium, Finland, France, Italy, The Netherlands, Spain, Sweden, and Switzerland). A total of 267,994 have been randomized to screening vs. control. An interim look at the data has taken place in 2006; the advice of the Data Monitoring Committee was to continue the study. This was based on a total of 23,794 deaths in both study groups, 6,033 cases of prostate cancer detected in both groups of which about 1, 200 had died. Contributions to a better understanding of the screening methodology. ERSPC has contributed with a large number of publications, either coming from individual centers or combining data of several centers. A complete listing can be found at www.erspc.org. Lead-time and overdiagnosis with the screening regimen utilized in ERSPC Rotterdam were established to amount to 10.3 years and 54%. This information is of great importance for the development of further screening strategies. During the process of ERSPC, digital rectal examination was omitted and replaced by the inclusion of PSA 3-4 as a biopsy indication. The data on which this decision has been based were published and validated. Overdiagnosis and overtreatment have an adverse influence on quality of life, as it will be included in the evaluation of ERSPC. The recent development of a nomogram for the identification of indolent disease is a major step to improve on this outcome parameter. The application of this nomogram to screen detected cases allows the the advice "active observation" to about 30% of such patients. ERSPC is set to show or exclude at least a 25% reduction in prostate cancer mortality through screening. Many pending problems still have to be resolved prior to the introduction of populations based screening as a worldwide healthcare policy.