The 29th annual European Association of Urology (EAU) Congress took place from April 11 to 15, 2014, in Stockholm, Sweden.  A major highlight of the meeting was the presentation of updated data from two major European randomized studies of prostate cancer screening.

The European Randomized Study of Screening for Prostate Cancer (ERSPC), which had previously reported its 11-year follow-up data,¹ presented new data from up to 13 years of follow-up and also incorporated French data for the first time.² During the first 11 years, the screening group had a 1.66-fold increased relative risk (RR) of prostate cancer diagnosis compared with control subjects (95% confidence interval [CI], 1.60-1.73). Interestingly, this incidence difference was slightly attenuated when evaluating the full 13-year data (RR, 1.57; 95% CI, 1.51-1.62), likely due to increased contamination in the control group later in the trial.

Meanwhile, screening continued to show a significant reduction in prostate cancer mortality (absolute rate difference −0.11; 95% CI, −0.18 to −0.05; and RR, 0.79; 95% CI, 0.69-0.91; P 5 .001) compared with controls in the intent-to-treat analysis.  By 13 years, the numbers needed to screen and diagnose to prevent one prostate cancer death decreased to 781 and 27, respectively. As in their previous publications, the authors again found an even greater mortality benefit when restricting the analysis to screening attendees (RR, 0.73). Finally, there was no significant difference in all-cause mortality between the groups (RR, 1.0; 95% CI, 0.98-1.02), but the trial was not powered to examine overall mortality.

The 18-year update of the Gothenburg population-based randomized screening trial in Sweden³ was also presented at the EAU congress. As in the overall ERSPC, they found that prostate-specific antigen (PSA) screening led to a significant reduction in prostate cancer mortality (absolute risk reduction, 0.42%; relative risk reduction, 33%).  At 18 years, the number needed to invite was 200 and the number needed to diagnose was only 9 to prevent 1 prostate cancer death.   They also showed that initiating screening after age 60 was too late.  

In a separate presentation, the Gothenburg investigators compared organized screening in the intervention arm with opportunistic screening in the control arm.⁴ The numbers needed to invite and diagnose to save a life were much higher with opportunistic screening (1190 and 55 at 16 years, respectively). They concluded that opportunistic screening had a much smaller effect on prostate cancer mortality and a greater risk of over-diagnosis compared with organized screening.

Finally, investigators from the Rotterdam section of the ERSPC presented a novel mobile tool to help guide prostate biopsy decisions in the clinical setting.⁵ This Rotterdam Prostate Cancer Risk Calculator was debuted at the Congress and is now available for smartphones and tablets.  The user can input data on PSA, digital rectal examination, previous prostate biopsies, prostate volume, transrectal ultrasound results, and the Prostate Health Index.  The calculator then uses the individual data to generate outputs of biopsy-detectable prostate cancer and significant cancer risk (defined as Gleason score ≥ 7 and/or stage ≥ T2b). Roobol and colleagues⁵ showed that including multiple variables together improved the predictive accuracy for biopsy outcome, compared to making decisions based on PSA alone. 

References

1. Schroder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med. 2012;366:981-990.
2. Hugosson J. Update European Randomized Study of Screening for Prostate Cancer (ERSPC). Presented at: 29th Annual European Association of Urology ­Congress; April 11-15, 2014; Stockholm, Sweden. 
3. Hugosson JE, Aus G, Carlsson S, et al. 18-year follow-up from the Gothenburg randomized prostate cancer screening trial, in European Association of Urology. Presented at: 29th Annual European Association of Urology Congress; April 11-15, 2014; Stockholm, Sweden. Abstract 848.
4. Godtman R, Holmberg E, Stranne J, Hugosson J. A comparison of the effectiveness of organised versus opportunistic screening measured as number needed to invite (NNI) and number needed to diagnose (NND).  Results from the Gothenburg randomised population-based prostate cancer screening trial. Presented at: 29th Annual European Association of Urology Congress; April 11-15, 2014; Stockholm, Sweden. Abstract 850.
5. Roobol M, Salman J, Azevedo N. The Rotterdam prostate cancer risk calculator: improved prediction with more relevant pre-biopsy information, now in the palm of your hand. Presented at: 29th Annual ­European Association of Urology Congress; April 11-15, 2014; Stockholm, Sweden. Abstract 857.