Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Acta Oncol. 2011 Jun;50 Suppl 1:4-11. doi: 10.3109/0284186X.2010.522197.
In 2009, the European Randomized Study of Screening for Prostate Cancer (ERSPC) was one of two studies to report interim data on the effect of screening for prostate cancer (PC) on the disease specific mortality. Contradictory results caused considerable discussion and misunderstanding in secondary literature.
This document is based on a non systematic review of recent evidence for and against screening for PC, specifically considering three recently published randomized screening trials [ 1-3 ].
The ERSPC data are based on a core age group of 162 387 men, aged 55-69 years, who were identified through population registries in seven European countries. Men were randomized between a screening group that received screening at an average of once every four years and a control group. After a median follow-up of nine years, a reduction in the rate of death from PC by 20% was shown which increased to 31% after adjusting for non-compliance and contamination. Overdetection and subsequent overtreatment (with a number needed to treat (NNT) of 48) are considered to be the major down sides of screening. The recently published 14-year results have shown that these down sides strongly depend on the duration of follow-up. In response to the outcomes of the ERSPC, several points of discussion have been brought up by various authors concerning the usefulness of screening considering benefits, harms and costs, the methodology of the ERSPC and the interpretation of its outcomes. Important issues to address regarding PC screening are addressed.
This paper sheds a light on the controversial points of the ERSPC as well as on the priority issues of PC screening. On July 2, 2010 the Swedish section of ERSPC (Göteborg screening trial) published their results with a median follow-up of 14 years. With longer follow-up the data confirm the trend seen in improvement of PC mortality and suggest much more favorable future outcomes also with respect to the NNT to prevent one PC death.
2009 年，欧洲前列腺癌筛查随机研究（ERSPC）是两项报道前列腺癌（PC）筛查对疾病特异性死亡率影响的中期数据研究之一。相互矛盾的结果在二级文献中引起了相当多的讨论和误解。
本文件基于对 PC 筛查利弊的最新证据进行的非系统性综述，特别是考虑了最近发表的三项随机筛查试验[1-3]。
ERSPC 数据基于一个核心年龄组的 162387 名 55-69 岁的男性，这些男性是通过七个欧洲国家的人口登记处确定的。男性被随机分配到筛查组和对照组。在中位随访 9 年后，PC 死亡率降低了 20%，调整不依从性和污染后增加到 31%。过度检测和随后的过度治疗（需要治疗的人数（NNT）为 48）被认为是筛查的主要缺点。最近发表的 14 年结果表明，这些缺点在很大程度上取决于随访时间。针对 ERSPC 的结果，不同作者就筛查的益处、危害和成本、ERSPC 的方法学以及其结果的解释提出了一些值得讨论的问题。
本文阐述了 ERSPC 的争议点以及 PC 筛查的重点问题。2010 年 7 月 2 日，ERSPC 的瑞典分部（哥德堡筛查试验）公布了他们的 14 年中位随访结果。随着随访时间的延长，数据证实了 PC 死亡率改善的趋势，并表明在预防一例 PC 死亡的 NNT 方面，未来的结果也更加有利。
