Prostate Cancer Screening in the Randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: Mortality Results after 13 Years of Follow-up

Abstract

After 13 years of follow-up, there was no evidence of a mortality benefit for organized annual screening in the PLCO trial compared with opportunistic screening, which forms part of usual care, and there was no apparent interaction with age, baseline comorbidity, or pretrial PSA testing.

PSA screening for prostate cancer: why so much controversy?

“…Contrary to the data of the ERSPC and Quebec studies, even the most recent update of the US PLCO study (76 685 men aged 55-74 years) followed up to 13 years reports no difference in the deaths from prostate cancer in the planned 'screened' versus 'control (usual care)' arms with 158 prostate cancer deaths in the intervention arm and 145 deaths in the 'control' arm 15,16 (Table 1).…”

“…14 An interesting observation in the PLCO study, however, is that considering men with no or minimal comorbidity 21 which represented 64% of the total population, the risk of death from prostate cancer was decreased by 44% (P50.03) 21 and 27% (P50.03). 15 Does this mean that men with significant comorbidity did not follow screening and treatment to the same extent as the men in relative good general health?…”

“…With the knowledge of these numbers, it is somewhat surprising to read under Methods in the summary of the last PLCO publication 'control usual care, which sometimes included opportunistic screening'. 15 It would seem that the word 'sometimes' does not best describe the situation. Comparison of strengths/weaknesses of prostate cancer screening studies F Labrie et al 604…”

“…Moreover, in the discussion of the last PLCO report, 15 it seems difficult to reconcile the extent of contamination mentioned above with the following sentence: 'the level of screening in the intervention arm was substantially greater than in the control arm…'. The authors admit the following in the discussion of the last PLCO report: 15 'the trial was evaluating the effect of adding an organized component of annual screening to the opportunistic screening already in place'.…”

“…The authors admit the following in the discussion of the last PLCO report: 15 'the trial was evaluating the effect of adding an organized component of annual screening to the opportunistic screening already in place'. Since 45% and 52% of men had screening before and during the trial, respectively, in the 'control/usual care' arm, the PLCO trial is not a trial evaluating the effect of screening on prostate cancer death since, as mentioned above, 19 only 12% more men had screening in the intervention arm.…”