Which men benefit from prostate cancer screening? Prostate cancer mortality by subgroup in the European Randomised Study of Screening for Prostate Cancer

Niko Pasanen; Kirsi Talala; Sebastiaan Remmers; Teuvo L J Tammela; Jonas Hugosson; Monique J Roobol; Kimmo Taari; Rebecka Arnsrud Godtman; Chris Bangma; Anssi Auvinen

doi:10.1111/bju.16394

Which men benefit from prostate cancer screening? Prostate cancer mortality by subgroup in the European Randomised Study of Screening for Prostate Cancer

BJU Int. 2024 May 9. doi: 10.1111/bju.16394. Online ahead of print.

Authors

Niko Pasanen^{1

2}, Kirsi Talala³, Sebastiaan Remmers⁴, Teuvo L J Tammela^{2

5}, Jonas Hugosson^{6

7}, Monique J Roobol⁴, Kimmo Taari^{8

9}, Rebecka Arnsrud Godtman^{6

7}, Chris Bangma⁴, Anssi Auvinen¹

Affiliations

¹ Faculty of Social Sciences, Tampere University, Tampere, Finland.
² Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
³ Finnish Cancer Registry, Helsinki, Finland.
⁴ Department of Urology, Erasmus University Medical Centre, Cancer Institute, Rotterdam, The Netherlands.
⁵ Department of Urology, Tampere University Hospital, Tampere, Finland.
⁶ Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of Urology, Helsinki University Hospital, Helsinki, Finland.
⁹ Faculty of Medicine, University of Helsinki, Helsinki, Finland.

PMID: 38725182
DOI: 10.1111/bju.16394

Abstract

Objective: To evaluate whether a subgroup of men can be identified that would benefit more from screening than others.

Materials and methods: This retrospective cohort study was based on three European Randomised Study of Screening for Prostate Cancer (ERSPC) centres, Finland, the Netherlands and Sweden. We identified 126 827 men aged 55-69 years in the study who were followed for maximum of 16 years after randomisation. The primary outcome was prostate cancer (PCa) mortality. We analysed three age groups 55-59, 60-64 and 65-69 years and PCa cases within four European Association of Urology (EAU) risk groups: low, intermediate, high risk, and advanced disease.

Results: The hazard ratio (HR) for PCa mortality in the screening arm relative to the control arm for men aged 55-59 years was 0.96 (95% confidence interval [CI] 0.75-1.24) in Finland, 0.70 (95% CI 0.44-1.12) in the Netherlands and 0.42 (95% CI 0.24-0.73) in Sweden. The HR for men aged 60-64 years was 1.03 (95% CI 0.77-1.37) in Finland, 0.76 (95% CI 0.50-1.16) in the Netherlands and 0.97 (95% CI 0.64-1.48) in Sweden. The HR for men aged 65-69 years was 0.80 (95% CI 0.62-1.03) in Finland and 0.57 (95% CI 0.38-0.83) in the Netherlands, and this age group was absent in Sweden. In the EAU risk group analysis, PCa mortality rates were materially lower for men with advanced disease at diagnosis in all three countries: 0.67 (95% CI 0.56-0.82) in Finland, 0.28 (95% CI 0.18-0.44) in the Netherlands, and 0.48 (95% CI 0.30-0.78) in Sweden.

Conclusion: We were unable to unequivocally identify the optimal age group for screening, as mortality reduction differed among centres and age groups. Instead, the screening effect appears to depend on screening duration, and the number and frequency of screening rounds. PCa mortality reduction by screening is largely attributable to stage shift.

Keywords: Finland; Sweden; mortality; prostate cancer; randomised trials; screening; the Netherlands.

Abstract

Grants and funding