Episode 18: PSA-based screening for prostate cancer: 21-year follow-up of the Rotterdam section of the ERSPC study

In this new episode of ‘What’s New Doc’ in Prostate cancer, Prof Bertrand Tombal from the Cliniques Universitaires Saint-Luc in Brussels, and Prof Steven Joniau from the University Hospitals Leuven discuss the recently published, 21-year follow-up data of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

The ERSPC study was initiated in 1993, with the primary aim to investigate the effect of regular prostate-specific antigen (PSA) screening on prostate cancer mortality. In the Rotterdam section of the ERSPC trial, 42,376 men between 55 and 74 years of age were randomly assigned to a screening or control arm. In short, the screening protocol consisted of PSA testing with a 4-year interval, with a PSA level of ≥3.0 ng/ml triggering a transrectal ultrasonography–guided biopsy.¹ After 16 years of median follow-up, the screening protocol was associated with a significant  20% reduction in the prostate-cancer specific mortality.¹ In an updated presentation of this study, with a median follow-up of 21 years, this prostate cancer specific mortality benefit had increased to 27% (HR[95%CI]: 0.73[0.61-0.88]).² In addition, also the number needed to invite to prevent 1 prostate cancer death continued to drop over time, from 570 at 16 years to 246 after 21 years. Finally, this ERSPC update showed that the prevention of one prostate cancer death required the diagnosis of 14 prostate cancers.² 

In their discussion of these results, Prof Tombal and Prof Joniau note that the reported number needed to invite, and the number needed to detect compare favorably to screening programs for other tumor types. Historical discussions on prostate cancer screening consistently underscored the risk of overtreatment. However, given the availability of MRI scans, PSA density calculations, targeted biopsies, and active surveillance, this argument is no longer valid anno 2024 according to Prof Tombal

As such, these updated ERSPC data provide further support for the implementation of PSA-based prostate cancer screening program. In this respect, several pilot projects have recently been launched under the umbrella of the European PRAISE-U project.