Background The European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% prostate cancer mortality reduction among screened men after 11 years. However, it is uncertain to what extent harms from overdiagnosis and treatment on quality of life counterbalance this benefit. Methods Based on ERSPC follow-up data, we used micro-simulation modeling (MISCAN) to predict the number of prostate cancers, treatments, deaths and quality-adjusted life-years (QALYs) gained following the introduction of screening. Various screening strategies, efficacies, and quality of life assumptions were modeled. Results Per 1,000 men of all ages followed for their entire lifespan we predicted for annual screening from age 55–69 years: 9 fewer deaths due to prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and 73 life-years gained (average 8.4 years per prostate cancer death avoided). QALYs gained were 56 (range: −21, 97), a reduction of 23% from unadjusted life-years gained. The number needed to screen (NNS) was 98 and number needed to detect (NND) 5. Also inviting men aged 70–74 resulted in more life-years (82) but similar QALYs (56). Conclusions Although NNS and NND are more favorable than previously calculated, the benefit of PSA screening is diminished by loss of QALYs, that is dependent primarily on post-diagnosis long-term effects. Longer follow-up data from both the ERSPC and quality of life are essential before making universal recommendations regarding screening.

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Accurate assessment of the causes of death is crucial for a conclusive evaluation of the ongoing prostate cancer screening trials. Here, we report the validity of the official causes of death as compared with an independent expert review in the Finnish prostate cancer screening trial. Because nearly 80,000 men were involved, death-cause evaluation was restricted to men diagnosed for prostate cancer. Medical charts were retrieved and the cause of death was assigned by an expert review panel for all deaths among men with prostate cancer during the study period, 1996-2003. The panel decision was compared with both death certificates and the official causes of death as assigned by Statistics Finland. Of a total of 315 deaths, the review panel attributed 127 (41%) to prostate cancer and 184 (59%) to other causes, the corresponding figures in death certificates being 124 (40%) and 187 (60%). Four cases were excluded because of insufficient information. The death-certificate data were in agreement with the panel's assessment in 305 out of 311 cases (overall agreement 97.7%, j 5 0.95). The overall agreement between the official causes of death and the panel's decision was 97.4% (304/311, j 5 0.95). The sensitivity of the certificates in identifying prostate cancer deaths was 96.1% (panel as golden standard). Correspondingly, specificity was 98.9%. The official causes of death thus provide an accurate means for evaluating disease-specific mortality in a large population-based prostatecancer screening trial in Finland. ' 2007 Wiley-Liss, Inc.Key words: prostate cancer; prostate-specific antigen; mass screening; cause of death; mortality; randomized trials Prostate cancer mortality is declining in some parts of the world, e.g., in the United States.1 Widespread debate has prevailed as to the extent to which the decrease may be a consequence of prostate-specific antigen (PSA)-based screening. The only valid means of settling the issue is through large randomized screening trials. Such trials are currently under way in both the United States (Prostate, Lung, Colorectal and Ovary screening trial, PLCO) and Europe (European Randomized Study of Prostate Cancer Screening, ERSPC), and the first mortality results are expected within a few years.2 Nevertheless the value of these ongoing trials has been questioned by suggesting that it would be almost impossible to demonstrate (or rule out) the value of PSA screening on account of possible misdiagnosis of the cause of death in elderly men with multiple comorbidities.3 Accurate assessment of the underlying cause of death is thus crucial for a conclusive evaluation of the possible benefits of prostate cancer screening. For several chronic conditions, a panel of experts has been regarded as the preferred strategy to establish cause-specific mortality for research purposes. [4][5][6] However, the use of death certificates has also been advocated to avoid labor-intensive and costly death reviews in large epidemiological studies. 7The Finnish prostate cancer screening trial is a part of ...

Our findings provide no support for selective screening among men with affected relatives.