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Evevident
Original paper
2009NEJMPreventive/Primary Care

ERSPC

Screening and prostate-cancer mortality in a randomized European study

RCTCancer screening

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Overview

European PSA screening reduced prostate-cancer mortality but caused substantial overdiagnosis.

Clinical takeaway

ERSPC provides the positive side of the PSA screening evidence, but the benefit is modest and tightly linked to overdiagnosis and treatment harms.

Key result

PSA screening reduced prostate-cancer mortality by about 20% in the initial report.

Practice impact

PSA screening should be offered through shared decision-making, not automatic population testing.

Evidence

Study design

Randomized screening trial.

Enrollment

182,160

Follow-up

Median 9 years in the initial report.

Geography

Europe

Clinical question

Does PSA-based prostate cancer screening reduce prostate-cancer mortality?

Population

  • Men mostly 55 to 69 years old in European screening centers.

Intervention

PSA-based screening at regular intervals.

Comparator

No organized screening.

Primary outcome

Prostate-cancer mortality.

PSA-based screening reduced prostate-cancer mortality but at the cost of overdiagnosis.

Rate ratio / 0.8 / CI 95% CI 0.65-0.98 / p=0.04

Key results

  • Prostate-cancer mortality was reduced in the screening group.
  • Absolute benefit was modest in the initial report.
  • Overdiagnosis was substantial.

Harms

  • False positives, biopsy complications, overdiagnosis, and treatment-related urinary/sexual harms are central.

Clinical Use

When to cite

  • When explaining why PSA screening is a shared decision with possible mortality benefit and real harms.

Practice impact

  • Balanced PLCO by demonstrating a prostate-cancer mortality reduction under organized European screening.

Applicability

  • Men considering PSA screening after discussion of absolute benefit and downstream harms.

Limitations

  • Screening protocols varied by country.
  • Longer follow-up changes absolute benefit estimates.

Common misinterpretations

  • Do not cite ERSPC as a mandate for universal PSA screening; overdiagnosis is part of the result.

Related evidence

PLCO - Contrasting Result

Citation

Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320-1328. doi:10.1056/NEJMoa0810084