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.

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.

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).

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

Scandinavian journal of urology. 2017 Dec 18 [Epub]

Jonas Hugosson, Rebecka Arnsrud Godtman, Sigrid V Carlsson, Gunnar Aus, Anna Grenabo Bergdahl, Pär Lodding, Carl-Gustaf Pihl, Johan Stranne, Erik Holmberg, Hans Lilja

a Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden., d Department of Urology , Carlanderska Hospital , Gothenburg , Sweden., e Department of Pathology, Institute of Biomedicine , Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden., f Department of Oncology, Institute of Clinical Sciences , Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden., b Department of Surgery (Urology Service) , Memorial Sloan Kettering Cancer Center , New York , NY , USA.