The Effect of Screening on the Rate of Death From Prostate Cancer

Rick G. Kulkarni, MD, FACEP


May 15, 2009

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 This is the Medscape Medical Minute. I'm Dr. Rick Kulkarni.

Is there a mortality benefit with regard to prostate cancer from regular prostate-specific antigen (PSA) testing and digital rectal examination (DRE)? The answer is unclear. Several investigators affiliated with the Washington University School of Medicine report in The New England Journal of Medicine in 2009 from the Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial on 76,693 men who were randomly assigned from 1993 to 2001 to receive either annual screening, defined as annual PSA testing for 6 years and DRE for 4 years, which resulted in 85% compliance with testing, or usual care, which resulted in PSA and DRE screening between 40% and 52% of the time, as the control group.[1] The main outcome measure was the incidence of prostate cancer. At 7 years of follow-up, the incidence of prostate cancer deaths in the screening group per 10,000 person-years was 2.0 (50 deaths) compared to 1.7 (44 deaths) in the control group (rate ratio 1.13; 95% confidence interval 0.75-1.70). The results at 10 years of follow-up were similar. The confidence intervals are indeed wide, and several possible explanations are offered by the authors for the results. However, this large trial did show no reduction in prostate cancer mortality for patients who underwent regular screening.

This article is selected from Medscape Best Evidence.[2] I'm Dr. Rick Kulkarni.


1. Andriole GL, Crawford ED, Grubb RL, et al; PLCO Project Team. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-1319. Epub 2009 Mar 18.

2. Internal Medicine in Medscape Best Evidence, powered by McMaster. Available at: Accessed April 29, 2009.

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