[The screening of prostate cancer in 2009: overview of the oncology committee of the French Urological Association]

Abstract

Objective: To analyze the impact of screening on prostate cancer (PCa) mortality, and to discuss the main points of controversy regarding this screening.

Methods: A bibliographic analysis was made using Medline services (keywords: prostate cancer, screening). Only the randomized studies regarding the impact of PCa screening on specific mortality were taken into account.

Results: Two randomized studies, comparing one group of screened men with another group of nonscreened men, were published this year with conflicting results. The American study PLCO included 76,693 men. After a follow-up of 7 years, it did not report a significant difference in terms of specific mortality between both arms: 2/10,000 deaths in the control group versus 1.7/10,000 in the screened arm (RR=1.13; IC 95%: 0.75-1.7). The European study ERSPC included 182,160 men. After 9 years of follow-up, it showed a significant 20% reduction of specific mortality rate in the screened group (RR=0.80; IC 90%: 0.65-0.98; p=0.04). Methodologically, the European study seems to be superior to the American study, in which the control group was biased by a high percentage of preinclusion screening.

Conclusions: This is the first time that a large randomized study shows a benefit of PCa screening regarding specific mortality. However, this issue remains to be clarified, due to the lack of data regarding the risk of "overdiagnosis" and the economic impact of screening.