Correlation between stage shift and differences in mortality in the European Randomized study of Screening for Prostate Cancer (ERSPC).

A 21% prostate cancer (PCa) mortality reduction was observed in the European Randomized Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. A direct correlation between stage shift and changes in PCa-mortality would support earlier detection through screening as the main reason for this reduction. In this study we empirically estimate how changes in the risk of being diagnosed with (advanced) PCa are related to the changes in PCa death in the ERSPC using a meta-regression approach. In total 81% and 89% of the changes in PCa mortality could be explained by changes in PCa incidence. Although this analysis cannot show direct causal relations, results support the hypothesis that PSA screening reduced PCa mortality by detecting cancer at an earlier stage while still curable. These findings do however not open the way to unrestricted PSA based screening for PCa. A balance between harm and benefit needs to be found. This article is protected by copyright. All rights reserved.