[Mortality due to prostate cancer in the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Results after a 15-year follow-up]

Objective: To address if prostate cancer (PCa) screening decreases PCa mortality in the asymptomatic population, within the setting of the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

Material and methods: From 1996 to 1999, 4,278 men aged 45-70 years were recruited and randomized to the screening arm (PSA every 4 years, prostate biopsy when PSA ≥3 ng/ml) and control arm (no tests). Dates and causes of death were collected on an annual basis. A Kaplan-Meier analysis was used to calculate overall and cancer-specific survival.

Results: A total of 2,416 men were recruited in the screening arm and 1,862 in the control arm. Mean age was 57.8 years, median follow-up was 13.3 years. At the end of the follow-up period, 427 deaths (9 from PCa) were observed. Survival analysis did not show any difference between the study arms with respect to overall and cancer-specific survival (p=0.939 and p=0.544 respectively). Most relevant causes of death were malignant tumors (52.9%), cardiovascular disease (17.3%) and respiratory (8.9%). Only 2.1% of deaths (0.2% of all recruited men) were due to PCa (2.5% screening, 1.6% control).

Conclusions: The Spanish arm of ERSPC failed to reproduce the long-term results shown in the whole study. No differences in mortality (overall or cancer-specific) were observed after 15 years of follow-up. PCa mortality was infrequent (less than 1%). These results suggest limited yield of PCa screening in our setting.