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European UrologyVolume 62, issue 5, pages e83-e94, November 2012
Letters to the Editor published online
Re: Fritz H. Schröder, Jonas Hugosson, Sigrid Carlsson, et al. Screening for Prostate Cancer Decreases the Risk of Developing Metastatic Disease: Findings from the European Randomized Study of Screening for Prostate Cancer (ERSPC). Eur Urol 2012;62:745–52
Accepted 11 July 2012, Published online 25 July 2012, page e89
Refers to article:
Screening for Prostate Cancer Decreases the Risk of Developing Metastatic Disease: Findings from the European Randomized Study of Screening for Prostate Cancer (ERSPC)
Accepted 31 May 2012
November 2012 (Vol. 62, Issue 5, pages 745 - 752)
The report of an absolute risk reduction of metastatic disease of 3.1 per 1000 men randomized to screening in the European Randomized Study of Screening for Prostate Cancer (ERSPC) deserves caution . First, this is a post hoc analysis of a secondary end point in a subgroup of the whole trial. Second, as observed in the methods section, the diagnosis of metastatic disease lacked rigor and was retrospective—“patients with a PSA [prostate-specific antigen] value >100 ng/ml were considered to have metastatic disease if imaging studies were not reported”—despite the European Society for Medical Oncology recommendation that radionuclide bone scans be performed at initial staging if patients have PSA levels >20 ng/ml, chronic bone pain, or fractures . Third, this report conflicts with the findings from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), which had a longer follow-up (13 yr) and did not find significant effects of screening but, as expected, found an increase in stage IV prostate cancers in the screened group during the beginning of the follow-up  and . In the screened populations, incidence of stage IV prostate cancers was 2.5 per 10 000 in the PLCO trial versus 3.3 for metastatic disease in the ERSPC trial. In contrast, figures were markedly different in the control populations: 2.8 versus 6.9, respectively. A significantly lower quality of prostate cancer treatment in the control group may explain the high rate of metastatic disease in the ERSPC trial .
We request that the authors provide a graph with the cumulative numbers of metastatic disease in both arms, as in the PLCO trial .
Conflicts of interest
The authors have nothing to disclose.
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-  G. Aus, C.C. Abbou, M. Bolla, et al. EAU guidelines on prostate cancer. Eur Urol. 2005;48:546-551 Abstract, Full-text, PDF, Crossref.
-  G.L. Andriole, E.D. Crawford, R.L. Grubb III, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104:125-132 Crossref.
-  P.C. Prorok, A.B. Miller, B.S. Kramer. Response: re: prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104:793-794 Crossref.
-  T. Wolters, M.J. Roobol, E.W. Steyerberg, et al. The effect of study arm on prostate cancer treatment in the large screening trial ERSPC. Int J Cancer. 2010;126:2387-2393
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© 2012 European Association of Urology, Published by Elsevier B.V.
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