The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is a multi-center, randomized trial aimed at determining disease-specific mortality outcomes. The goal relative to prostate cancer was to determine if a reduction in prostate cancer mortality would occur through screening via PSA and DRE. A recent manuscript summary reported data 13 years in follow-up after the trial.
Nearly 77,000 men ages 55-74 years were randomly assigned to either screening via PSA screening for 6 years and DRE for 4 years versus usual care, which included “opportunistic screening”. At 13 years, 4250 men were diagnosed with prostate cancer in the screening group versus 3815 in the control group. Cumulative data discovered a 12% increase in prostate cancer incidence in the screening group, yet mortality in the intervention and control groups were 3.7 and 3.4/10,000 person/years, respectively (relative risk = 1.09). There was a non-statistically significant decrease in incidence of high-grade prostate cancer in the intervention screening group.
This data suggests that no mortality benefit was observed for routine screening for prostate cancer via PSA and DRE after 13 years of follow-up. In contrast, the European Randomized Study for Prostate Cancer (ERSPC) trial published in the New England Journal of Medicine in 2009 reported a 20% reduction in prostate cancer mortality after 10 years of follow-up in men ages 55-69. However, in the PLCO trial, 45% of men had at least one PSA in the 3 years prior to randomization, while 52% of men had a PSA during the screening period; the rate of screening in the control group was approximately 50% that of the intervention group. The authors state that they plan to update this data after 15 years of total follow-up. Lastly, they suggest caution in determining efficacy of prostate cancer screening as their results demonstrate the effect of adding regular screening in addition to opportunistic screening , as to date, there is no evidence of benefit.
Reference: Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up. J Natl Cancer Inst 2012;104:1-8.